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The Malignant Potential Of Small Renal Masses
Deborah T Glassman, Joshua P Sleeper*, Dolores Byrne*, Edouard J Trabulsi, Leonard G Gomella
Thomas Jefferson University, Philadelphia, PA
Introduction: Increasing numbers of renal masses are discovered incidentally, many which are smaller than 4 centimeters. Since the primary therapy for renal cell carcinoma is surgical, it is crucial to be able to identify which masses are more likely to represent malignant processes that would require aggressive treatment. The purpose of this study is to evaluate the frequency of malignant disease in small renal masses based on size and to determine the predictive value of size to final histopathology.
Methods: We performed a retrospective review of all renal extirpative surgery performed at our institution between 1998 and 2006. We categorized lesions by size as reported on pathologic reports. Chi square test was performed to assess statistical significance with p< 0.01 as a significant value.
Results: 473 patients with a total of 565 masses underwent surgical treatment. 336 (59.9%) had masses under 4cm. 230 (68.5%) were malignant. Of the malignant lesions: 24 lesions (7.1%) were < 1 cm in size, 44 (13.1%) were 1-2 cm, 84 (25%) were >2-3cm and 78 (23.4%) were >3-4cm.
Conclusions: The overall malignancy rate of renal lesions <4cm is 68.5% and is consistent with our previously reported series. Our data suggest that lesions < 2cm have a significantly lower rate of malignancy (p=0.0027) than those greater than 2cm. Recent evidence suggests that renal tumors less than 4cm may be safely monitored with careful observation. Our data corroborates this finding, particularly for masses less than 2cm in size.
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