AUA 2017: Society of Urologic Oncology: Cystic renal masses – Radiographic assessment and management

Boston, MA (UroToday.com) In this session, Dr. Ficarra provided a thorough review on cystic renal lesions and their management. He reminded the audience of the Bosniak criteria for characterizing cystic renal masses and that the likelihood of malignancy increases in lockstep with increasing Bosniak score.

To facilitate the case discussion, Dr. Ficarra presented two cases. The first was a 54-year old female with no comorbidities who presented with an incidentally detected complex 2cm Bosniak II lesion in the left kidney. Given the known incidence of malignancy at 20-25% in these lesions, the patient was followed with interval imaging. At 24 months, the tumor had increased in size and complexity to a 4cm Bosniak III lesion. At this point, Dr. Ficarra took time to recommend against biopsy in this population since the sensitivity approaches only 83%. Given the more than 50% chance of malignancy for Bosniak III lesions, the patient was taken to surgery where a partial nephrectomy was performed. Final pathology demonstrated clear cell renal cell carcinoma, Fuhrman grade 2, pT1a with negative surgical margins.

Case two was a 63-year old male patient with an asymptomatic Bosniak III lesions. Again, given the high risk of malignancy, the patient was taken to surgery where a partial nephrectomy was performed. Final pathology represented a multilocular cystic renal cell carcinoma. Recent data have demonstrated favorable survival outcomes in these patients (Bhatt et al. J Urol 2016;196: 1350).

In conclusion, Dr. Ficarra noted that CT, MRI, and contrast-enhanced US represent the diagnostic tools to characterize cystic renal lesions. Category IIF lesions must be followed, while, category III/IV lesions are high-risk for malignancy and must be resected (unless patient is not a surgical candidate). Partial nephrectomy should be recommended in this tumor with preferential consideration favoring a minimally invasive approach. Lastly, multilocular cystic renal cell carcinomas usually have an excellent prognosis.

Presented by: Vincenzo Ficarra, MD

Written By: Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, PA

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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