Cary K Clint, Sundaram Chandru P
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Indian J Urol. 2009 Oct-Dec;25(4):489-93. doi: 10.4103/0970-1591.57923.
Objectives : To evaluate the role and feasibility of observation with regard to the small renal mass. Methods : We performed a literature search of MEDLINE, reviewing the world literature relevant to the natural history, role of percutaneous biopsy and surveillance of the small renal mass. Results : The average yearly growth rate of most small renal masses ranges from 0.1 to 0.70 cm/yr with obvious exceptions. Clinical predictors of growth such as radiographic size at presentation, age, gender and tumor characteristics are not reliable. Approximately 1% develops metastatic disease while under surveillance. Contemporary series of percutaneous biopsy of small renal masses report sensitivity for malignancy to be 90%-98%. However, false-negative results can occur. For the majority of patients, the gold standard remains surgical extirpation. Conclusions : Watchful waiting is an acceptable option for management of small renal masses in the surgically unfit and elderly population. More information regarding the natural history and metastatic potential of small renal masses is needed. Percutaneous needle biopsy can be successful in detecting malignancy in selected patients with small renal masses. The role of needle biopsy for the small renal mass continues to evolve.
评估观察在小肾肿块中的作用及可行性。方法：我们对MEDLINE进行了文献检索，回顾了与小肾肿块的自然病史、经皮活检的作用及监测相关的世界文献。结果：大多数小肾肿块的平均年生长率为0.1至0.70厘米/年，但有明显例外。生长的临床预测因素，如初次就诊时的影像学大小、年龄、性别和肿瘤特征并不可靠。在监测期间，约1%会发生转移性疾病。当代关于小肾肿块经皮活检的系列报道显示，恶性肿瘤的活检敏感性为90%-98%。然而，可能会出现假阴性结果。对于大多数患者来说，金标准仍然是手术切除。结论：对于手术不适合的患者和老年人群，密切观察是小肾肿块管理的一个可接受的选择。需要更多关于小肾肿块自然病史和转移潜能的信息。经皮针吸活检在部分小肾肿块患者中可成功检测出恶性肿瘤。针吸活检在小肾肿块中的作用仍在不断演变。
