Abstract
Objective
To investigate the incidence of pulmonary metastases (PM) and the utility of the surveillance
chest radiography (CXR) in detecting PM after curative treatment to better define
surveillance recommendations for T1a and T1b renal cell carcinoma.
Materials and Methods
A retrospective review of a multi-institutional database was performed to include
patients with renal masses treated with partial nephrectomy or radical nephrectomy.
Patients were excluded for ≥T2 disease, benign pathology, and metastases. The primary
outcome was the incidence of asymptomatic pulmonary lesion concerning for PM detected
by CXR within 3 years.
Results
Five hundred sixty-eight patients met criteria of which 384 had T1a and 184 had T1b
at a mean follow-up of 45 and 43 months, respectively. Patients averaged 2.96 and
2.99 CXRs for T1a and T1b with 46.8% having surveillance beyond 3 years. Indeterminate
lesions were found in 5.7% (22) of T1a and 5.4% (10) in T1b of which 0.01% (2) and
1.1% (2) were confirmed PM by chest computed tomography and biopsy. Three-year CXR
surveillance period detected asymptomatic PM in zero and two patients for T1a and
T1b, respectively. High risk pathological features were not present in patients with
PM. There was no difference in the incidence PM for patients undergoing partial nephrectomy
(3/290) or radical nephrectomy (1/278) (P = .62).
Conclusion
Our review suggests that post-treatment pulmonary surveillance should be reserved
for T1b and may not be required for T1a given the low yield and false positives of
CXR leading to unnecessary radiation and potential biopsies.
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Article info
Publication history
Published online: September 08, 2018
Accepted:
August 10,
2018
Received in revised form:
August 9,
2018
Received:
July 6,
2018
Identification
Copyright
Published by Elsevier Inc.
