Available active surveillance follow-up protocols for small renal mass: a systematic review

Adequacy of clinical guideline recommendations for patients with low-risk cancer managed with monitoring: systematic review

OBJECTIVES

The aim of this systematic review was to summarize national and international guidelines that made recommendations for monitoring patients diagnosed with low-risk cancer. It appraised the quality of guidelines and determined whether the guidelines adequately identified patients for monitoring, specified which tests to use, defined monitoring intervals, and stated triggers for further intervention. It then assessed the evidence to support each recommendation.

STUDY DESIGN AND SETTING

Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched PubMed and Turning Research into Practice databases for national and international guidelines' that were written in English and developed or updated between 2012 and 2023. Quality of individual guidelines was assessed using the AGREE II tool.

RESULTS

Across the 41 published guidelines, 48 different recommendations were identified: 15 (31%) for prostate cancer, 11 (23%) for renal cancer, 6 (12.5%) for thyroid cancer, and 10 (21%) for blood cancer. The remaining 6 (12.5%) were for brain, gastrointestinal, oral cavity, bone and pheochromocytoma and paraganglioma cancer. When combining all guidelines, 48 (100%) stated which patients qualify for monitoring, 31 (65%) specified which tests to use, 25 (52%) provided recommendations for surveillance intervals, and 23 (48%) outlined triggers to initiate intervention. Across all cancer sites, there was a strong positive trend with higher levels of evidence being associated with an increased likelihood of a recommendation being specific (P = 0.001) and the evidence for intervals was based on expert opinion or other guidance.

CONCLUSION

With the exception of prostate cancer, the evidence base for monitoring low-risk cancer is weak and consequently recommendations in clinical guidelines are inconsistent. There is a lack of direct evidence to support monitoring recommendations in the literature making guideline developers reliant on expert opinion, alternative guidelines, or indirect or nonspecific evidence.

Contrast-enhanced ultrasound (CEUS) of benign and malignant renal tumors: Distinguishing CEUS features differ with tumor size

BACKGROUND

Contrast-enhanced ultrasound (CEUS) is now a guideline-recommended strategy for diagnosing renal lesions. Tumor size is related to the risk of the treatment and prognosis in renal tumors. Thus, we aim to analyze the CEUS features of solid renal tumors in relation to tumor size.

METHODS

The CEUS appearance of 156 pathologically diagnosed solid renal tumors were retrospectively analyzed. Three groups were stratified according to the tumor size (≤2 cm [group I], 2.1-4 cm [group II] and 4.1-7 cm [group III]). For each group, the features of wash-in type, enhancement degree, enhancement homogeneity, and the presence of a pseudocapsule sign were compared between benign and malignant tumors.

RESULTS

All 156 included lesions were detected by CEUS. The proportion of benign tumors in three size groups was 37.1%, 19.4%, and 20.4%, respectively. The proportion of malignant tumors was highest (80.6%) in group II, followed by group III (79.6%) and group I (62.9%). In group I, malignant and benign tumors differed significantly in the presence of a pseudocapsule sign (p = 0.015) and homogeneity (p = 0.007). In group II, the degree of enhancement differed (p = 0.02) between tumor types. In group III, the two tumor types differed in both the wash-in pattern (p = 0.015) and enhancement degree (p = 0.024). The weighted and Cohen's kappa values for the concordance between inter-observer agreement ranged from 0.31 (95% CI: 0.36-0.57) to 0.90 (95% CI: 0.77-1.00).

CONCLUSIONS

CEUS features of malignant and benign renal tumors change along with the tumor size. The use of CEUS features in the diagnosis of benign and malignant tumors requires consideration of tumor size.