Diagnostic Imaging Pathways - Renal Cell Cancer (Staging)
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Population Covered By The Guidance
This pathway provides guidance on the staging of adult patients with renal carcinoma confirmed by biopsy or previous imaging.
Date reviewed: January 2012
Date of next review: 2017/2018
Published: November 2012
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SYMBOL | RRL | EFFECTIVE DOSE RANGE |
![]() | None | 0 |
![]() | Minimal | < 1 millisieverts |
![]() | Low | 1-5 mSv |
![]() | Medium | 5-10 mSv |
![]() | High | >10 mSv |
Images
Teaching Points
Teaching Points
- Staging is usually by CT of the abdomen and chest radiograph
- Other modalities used include chest CT if there is a suspicion of metastasis on chest radiography, nuclear medicine bone scan if the patient has bone pain and MRI or Doppler US if there is equivocal IVC invasion on CT
chest_ct
Chest Computed Tomography (CT)
- Indications 14
- When the chest radiograph is suspicious or positive or
- In large and locally aggressive tumours to help confirm or exclude metastases and defining the extent of disease
doppler
Doppler Ultrasound
- If MRI is unavailable, Dopper US is useful for assessment of tumour extension into the renal veins, the inferior vena cava, and the right side of the heart (sensitivity approaching 100% for delineating tumour thrombus in the intrahepatic or suprahepatic inferior vena cava) 6,7,8,9
- Advantages 1
- Non-invasive
- No exposure to ionising radiation
- Does not require contrast material
- Relatively inexpensive and widely available
- Limitations
- Inferior to CT and MRI for overall staging of renal adenocarcinoma (low sensitivity for detection of tumour thrombus in the infrahepatic inferior vena cava or distal renal vein) 7
- Image distortion secondary to bowel gas and fat
mri
Magnetic Resonance Imaging (MRI)
- Most accurate imaging modality for assessing venous thrombus (83-100% sensitivity) 5,6,7,10,11,12,13
- Indicated when there is equivocal renal vein or inferior vena caval involvement on CT 5,10
- Advantages 1
- Multiplanar imaging
- Superior soft tissue contrast
- Does not require intravascular contrast material
- No exposure to ionising radiation
- Disadvantages - limited availability and high expense
staging
Staging of Renal Cell Carcinoma
- The goal of imaging in patients with renal cell carcinoma is to separate candidates for surgical cure from those with advanced disease 1
- For surgical candidates, imaging allows delineation of the extent of disease for treatment planning 1
- Renal cell carcinoma staging system 1
Robson Stage |
Disease Extent |
TNM Stage |
---|---|---|
I |
Tumour confined to kidney (<2.5cm) |
T1 |
Tumour confined to kidney (>2.5cm) |
T2 |
|
II |
Tumour spread to perinephric fat or adrenal |
T3a |
IIIA |
Tumour spread to renal vein |
T3b |
Tumour spread to inferior vena cava |
T3c |
|
IIIB |
Tumour spread to local lymph nodes (LN) |
N1-3 M0 |
IIIC |
Tumour spread to local vessels and LNs |
T3b N1-3 |
IVA |
Tumour spread to adjacent organs (except ipsilateral adrenal) |
T4a |
IVB |
Distant metastases |
M1 N4 |
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Zagoria RJ, Bechtold RE. The role of imaging in staging renal adenocarcinoma. Semin Ultrasound CT MR. 1997;18(2):91-9. (Review article)
- Benson MA, Haaga JR, Resnick MI. Staging renal carcinoma: what is sufficient? Arch Surg. 1989;124(1):71-3. (Level II/III evidence)
- Dinney CPN, Lannon SG, Awad SA, et al. Analysis of imaging modalities, staging systems, and prognostic indicators for renal cell carcinoma. Urology. 1992;39(2):122-9. (Level II evidence). View the reference
- Johnson CD, Dunnick NR, Cohan RH, et al. Renal adenocarcinoma: CT staging of 100 tumours. AJR Am J Roentgenol. 1987;148(1):59-63. (Level III evidence)
- Fein AB, Lee JKT, Balfe DM. Diagnosis and staging of renal carcinoma: a comparison of MR imaging and CT. AJR Am J Roentgenol. 1987;148(4):749-53. (Level II/III evidence)
- Habboub HK, Abu-Yousef MM, Williams RD, et al. Accuracy of color Doppler sonography in assessing venous thrombus extension in renal cell carcinoma. AJR Am J Roentgenol. 1997;168:267-71. (Level III evidence)
- Kallman DA, King BF, Hattery RR, et al. Renal vein and inferior vena cava tumour thrombus in renal cell carcinoma: CT, US, MRI, and venacavography. J Comput Assist Tomogr 1992;16:240-7. (Level II evidence). View the reference
- Didier D, Racle A, Etievent JP, et al. Tumour thrombus of the inferior vena cava secondary to malignant abdominal neoplasms: US and CT evaluation. Radiology. 1987;162:83-9. (Level III/IV evidence)
- Schwerk WB, Schwerk WN, Rodeck G. Venous renal tumour extension: a prospective US evaluation. Radiology. 1985;156:491-5. (Level II evidence). View the reference
- Hricak H, Thoeni RF, Carroll PR, et al. Detection and staging of renal neoplasms: a reassessment of MR imaging. Radiology. 1988;166;643-9. (Level III evidence)
- Goldfarb DA, Novick AC, Lorig R, et al. Magnetic resonance imaging for assessment of vena caval tumor thrombi: a comparative study with venacavography and computerized tomography scanning. J Urol. 1990;144:1100-4. (Level III evidence)
- Semelka RC, Shoenut JP, Magro CM, et al. Renal cancer staging: comparison of contrast enhanced CT and gadolinium enhanced fat-suppressed spin-echo and gradient echo MR imaging. J Magn Reson Imaging. 1993;3(4):597-602. (Level II evidence)
- Horan JJ, Robertson VN, Choyke PL, et al. The detection of renal carcinoma extension into the renal vein and the inferior vena cava: a prospective comparison of venography and MRI. J Urol. 1989;142(4):943-7. (Level II/III evidence)
- Lim DJ, Carter MF. Computerized tomography in the preoperative staging of pulmonary metastases in patients with renal cell carcinoma. J Urol. 1993;150(4):1112-4. (Level III evidence)
- Campell RJ, Broaddus SB, Leadbetter GW Jr. Staging of renal carcinoma: cost effectiveness of routine pre-operative bone scans. Urology. 1985;25(3):326-9. (Level III evidence)
Further Reading
- Fritzsche PJ, Millar C. Multimodality approach to staging renal cell carcinoma. Urol Radiol. 1992;14:3-7. (Review article)
Information for Consumers
Information for Consumers
Information from this website |
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Consent to Procedure or Treatment Radiation Risks of X-rays and Scans Magnetic Resonance Imaging (MRI) |
Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
copyright
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