Introduction With the rise in the detection of incidental small renal masses (SRM), the management paradigm for these patients has become an issue of increasing concern. We aim to identify areas of consensus, controversy, and opportunities for improvement among recently published guidelines and assess the strength of evidence for the management of SRMs. Methods We reviewed practice guidelines for SRMs promulgated by the American Urological Association, European Association of Urology, National Comprehensive Cancer Network, American Society of Clinical Oncology, European Society for Medical Oncology, and the Chinese Society of Clinical Oncology. Levels of evidence and strength of recommendations for evaluation, management and follow-up were analyzed with regard to consensus, conflict, and neglect. Results There is consensus among guidelines for the initial evaluation and treatment of SRMs, however, discrepancies exist with regard to indications for active surveillance, thermal ablation and timing/method of follow-up after treatment. Routine renal mass biopsy is not recommended by any guideline. Overwhelmingly, guideline statements are based on low to moderate levels of evidence; only 23% of the reviewed guidelines were based on high-level evidence; 38% based on moderate and 39% on low-level evidence or expert opinion. Conclusions Despite all six guidelines sharing a consensus on most management topics regarding SRMs, the ongoing lack of high-level evidence precludes gold standard recommendations in the areas of diagnosis, treatment, and follow-up. More high-quality studies are needed in order to develop stronger, data-supported universal guideline for the management of SRMs.
Journal of endourology. 2023 May 31 [Epub ahead of print]
Pengbo Jiang, Sohrab Ali, Akhil Peta, Raphael B Arada, Andrew Brevik, Lillian Xie, Zhamshid Okhunov, Ralph Clayman, Jaime Landman
University of California Irvine, 8788, Urology, Irvine, California, United States; ., University of California Irvine, 8788, Urology, 3800 W Chapman Ave, Suite 7200, Irvine, California, United States, 92697; ., University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Irvine, California, United States, 92868; ., University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987; ., Kansas City University of Medicine and Biosciences College of Osteopathic Medicine, 472547, Urology, 1850 Whittier Ave, Apt G105, Costa Mesa, California, United States, 92627; ., University of California Irvine, 8788, Urology, Orange, California, United States; ., Northwell Health, 5799, 304 Community Drive, Apt 3R, Manhasset, New York, United States, 11030; ., University of California Irvine, 8788, Urology, 3800 Chapman Avenue, Suite 7200, Orange, California, United States, 92868; ., University of California Irvine, 8788, Urology, Orange, California, United States; .