Staging CT chest is not required in the diagnostic evaluation of patients with cT1a renal cell carcinoma
BAUS ePoster online library. Mains E.
Jun 27, 2018; 211379
Mr. Edward Mains
Mr. Edward Mains
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Abstract
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Introduction: Approximately 1/3 of patients with renal cell carcinoma (RCC) have metastates at diagnosis, with the most common site being pulmonary. As a result the European Association of Urology recommends staging CT chest for patients diagnosed with RCC and this has been adopted as a quality performance indicator in Scottish Cancer Networks. This may be associated with excess radiation exposure for some patients. Recent research has identified clinico-pathological parameters, which are predictive of risk of pulmonary metastases at diagnosis, with the aim of stratifying the use of CT chest. We aimed to validate these parameters and determine whether CT chest could be omitted in patients with cT1a RCC.

Methods: Patients with cT1 RCC diagnosed at a single institution between January 2012 and December 2016 were identified from a prospectively collected database. Baseline patient demographics, clinical and pathological TNM stage and treatment type were collected. Symptoms and blood results at presentation and follow-up were collected retrospectively.

Results: Of 383 patients diagnosed with cT1 RCC during the study period, 225 patients had cT1a tumours. 3(1.3%) patients had metastatic disease at diagnosis. Only 1(0.4%) patient had lung metastases, while all 3 had visceral abdominal metastases. All 3 patients were symptomatic of systemic disease and two had an abnormal full blood count.

Conclusion: Isolated lung metastases are rare in patients with cT1a RCC. In patients with cT1a RCC without additional predictive indicators, it may be safe to omit staging CT chest. We have initiated a Scottish national audit to validate these findings further.

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