Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, 610 University Avenue, Suite 3-130, Toronto, Ontario, M5G 2M9, Canada.
Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and the University of Sherbrooke, 3001-12ieme avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
Curr Urol Rep. 2017 Jan;18(1):7. doi: 10.1007/s11934-017-0653-3.
Over the last few decades, the incidence of renal cell carcinomas (RCCs) has been steadily increasing. This is primarily due to an increase in detection of small renal masses (SRMs) as a result of widespread utilization of abdominal imaging. Interestingly, up to 30% of incidentally discovered SRMs (solid lesions measuring ≤4 cm) are benign, and consequently, the definitive treatment of all SRMs is associated with a considerable risk of overtreatment. To decrease the overtreatment rate, renal tumour biopsy (RTB) has been advocated as a safe alternative to identify the pretreatment histology of these SRMs. Although initially fraught with high non-diagnostic rates, more recent series from centres of experience have demonstrated that RTB is safe, reliable and accurate. The future of SRM management will combine pathological, molecular and genetic information to improve our ability to predict the behaviour of these lesions and herald risk-adapted personalized treatment.
在过去几十年中，肾细胞癌 (RCC) 的发病率一直在稳步上升。这主要是由于腹部成像的广泛应用导致检测到的小肾肿块 (SRM) 数量增加。有趣的是，高达 30% 的偶然发现的 SRM（固体病变直径≤4cm）是良性的，因此，所有 SRM 的明确治疗都与过度治疗的风险相当大。为了降低过度治疗率，肾肿瘤活检 (RTB) 已被提倡作为一种安全的替代方法，以确定这些 SRM 的预处理组织学。尽管最初存在很高的非诊断率，但来自经验中心的最近系列研究表明，RTB 是安全、可靠和准确的。SRM 管理的未来将结合病理、分子和遗传信息，以提高我们预测这些病变行为的能力，并预示着风险适应的个性化治疗。
