Imaging work-up: is it renal carcinoma and is it operable?

In detection and work-up of a renal carcinoma, imaging plays the most critical role. Differentiation of renal cell carcinoma from angiomyolipoma and complex cysts is highly accurate, but differentiation from benign oncocytoma is not. The most important discoveries regarding local staging are presence of venous tumor thrombus and its cephalad extension, followed by regional lymph node metastases. Biopsy of a renal mass is indicated when a concomitant primary malignancy is present elsewhere, but only if treatment will be influenced by findings. Preoperative embolization is reserved for the most difficult cases, and palliative embolization is useful in selected cases. Helical computed tomography is the most sensitive method for detecting small lung metastases.