Management of Small Renal Masses: Literature and Guidelines Review
ABSTRACT Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs...
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Sociedade Brasileira de Urologia
2025-08-01
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| Series: | International Brazilian Journal of Urology |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382025000500301&lng=en&tlng=en |
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| author | Antonio Silvestri Filippo Gavi Maria Chiara Sighinolfi Simone Assumma Enrico Panio Daniele Fettucciari Giuseppe Pallotta Or Schubert Cristina Carerj Mauro Ragonese Pierluigi Russo Riccardo Bientinesi Nazario Foschi Chiara Ciccarese Roberto Iacovelli Bernardo Rocco |
| author_facet | Antonio Silvestri Filippo Gavi Maria Chiara Sighinolfi Simone Assumma Enrico Panio Daniele Fettucciari Giuseppe Pallotta Or Schubert Cristina Carerj Mauro Ragonese Pierluigi Russo Riccardo Bientinesi Nazario Foschi Chiara Ciccarese Roberto Iacovelli Bernardo Rocco |
| author_sort | Antonio Silvestri |
| collection | DOAJ |
| description | ABSTRACT Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs has evolved significantly over recent decades. Partial nephrectomy has become the standard surgical approach, while active surveillance (AS) has emerged as a viable alternative for select patients, particularly those with comorbidities or limited life expectancy. AS involves serial imaging to monitor tumor progression, reserving intervention for signs of clinical advancement. This review synthesizes oncological outcomes and current management strategies for SRMs, comparing AS with immediate intervention. A comprehensive literature search (2005–2024) was performed across PubMed, Web of Science, and Scopus, complemented by an analysis of major international guidelines (EAU, AUA, ESMO, CUA, and Latin American Renal Cancer Group). All guidelines support AS for selected patients with cT1a tumors, though criteria vary. The AUA limits AS to tumors <2 cm, while only its guidelines define clear triggers for transitioning from AS to treatment. Imaging surveillance intervals and biopsy indications also differ, with broader support for renal mass biopsy prior to ablation but more selective use during AS. This review underscores the importance of individualized decision-making in SRM management and highlights areas of consensus and divergence among contemporary guidelines. |
| format | Article |
| id | doaj-art-fb0585fbdfb74dd78da206b053504fcd |
| institution | DOAJ |
| issn | 1677-6119 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj-art-fb0585fbdfb74dd78da206b053504fcd2025-08-20T03:07:31ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-61192025-08-0151510.1590/s1677-5538.ibju.2025.0203Management of Small Renal Masses: Literature and Guidelines ReviewAntonio Silvestrihttps://orcid.org/0009-0008-2285-8231Filippo GaviMaria Chiara SighinolfiSimone AssummaEnrico PanioDaniele FettucciariGiuseppe PallottaOr SchubertCristina CarerjMauro RagonesePierluigi RussoRiccardo BientinesiNazario FoschiChiara CiccareseRoberto IacovelliBernardo RoccoABSTRACT Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs has evolved significantly over recent decades. Partial nephrectomy has become the standard surgical approach, while active surveillance (AS) has emerged as a viable alternative for select patients, particularly those with comorbidities or limited life expectancy. AS involves serial imaging to monitor tumor progression, reserving intervention for signs of clinical advancement. This review synthesizes oncological outcomes and current management strategies for SRMs, comparing AS with immediate intervention. A comprehensive literature search (2005–2024) was performed across PubMed, Web of Science, and Scopus, complemented by an analysis of major international guidelines (EAU, AUA, ESMO, CUA, and Latin American Renal Cancer Group). All guidelines support AS for selected patients with cT1a tumors, though criteria vary. The AUA limits AS to tumors <2 cm, while only its guidelines define clear triggers for transitioning from AS to treatment. Imaging surveillance intervals and biopsy indications also differ, with broader support for renal mass biopsy prior to ablation but more selective use during AS. This review underscores the importance of individualized decision-making in SRM management and highlights areas of consensus and divergence among contemporary guidelines.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382025000500301&lng=en&tlng=enKidney NeoplasmsWatchful WaitingAdenocarcinoma, Clear Cell |
| spellingShingle | Antonio Silvestri Filippo Gavi Maria Chiara Sighinolfi Simone Assumma Enrico Panio Daniele Fettucciari Giuseppe Pallotta Or Schubert Cristina Carerj Mauro Ragonese Pierluigi Russo Riccardo Bientinesi Nazario Foschi Chiara Ciccarese Roberto Iacovelli Bernardo Rocco Management of Small Renal Masses: Literature and Guidelines Review International Brazilian Journal of Urology Kidney Neoplasms Watchful Waiting Adenocarcinoma, Clear Cell |
| title | Management of Small Renal Masses: Literature and Guidelines Review |
| title_full | Management of Small Renal Masses: Literature and Guidelines Review |
| title_fullStr | Management of Small Renal Masses: Literature and Guidelines Review |
| title_full_unstemmed | Management of Small Renal Masses: Literature and Guidelines Review |
| title_short | Management of Small Renal Masses: Literature and Guidelines Review |
| title_sort | management of small renal masses literature and guidelines review |
| topic | Kidney Neoplasms Watchful Waiting Adenocarcinoma, Clear Cell |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382025000500301&lng=en&tlng=en |
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