A review of the benefits of staging Chest CT in newly diagnosed small renal tumours.
BAUS ePoster online library. Jenkins J. Jun 25, 2019; 259582; P8-6
James Jenkins
James Jenkins
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Abstract
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While renal cell carcinomas (RCCs) are increasingly diagnosed pre-clinically as incidental radiological findings, it is well documented that rates of synchronous metastasis at diagnosis remain high (10-20%) with the lungs most commonly affected. Conformingly, EAU guidelines advise full CT staging at diagnosis for all renal cancers.
Recent publications (including Larcher et al. BJUI 2017) raised questions over the objective benefit of performing CT chests in those with cT1a disease with chest metastasis pick up rates of <1%. To this end, we aimed to test this finding against a UK based population.

Retrospective review of all patients passing through a single tertiary centre MDT between 2011-2017 inclusively identified 1139 suspected RCCs including 479 T1aNxMx and 250 T1bNxMx. In both groups, baseline CT chest performance and positive findings were recorded.

Of those with T1a tumours, 82.3% underwent CT chest. Within this group, 89.8% of scans were clear, 2.3% showed lung primary tumours, 7.8% revealed indeterminate nodules (none later confirmed as metastatic disease), and 0.25% showed lung metastasis (later refuted on biopsy).
Of those with T1b disease, 92.0% underwent CT chest, with 88.7% reported clear, 6.9% showed indeterminate pulmonary nodules (75% stable or resolved on follow up), 0.9% showed primary lung pathology and 3.9% demonstrated clear metastatic disease.

These findings support those of Larcher et al, with synchronous metastatic lung detection rates for suspected T1aNxMx below the incidental pick up rates of lung primaries. Whilst further analysis is warranted, these findings question the underlying evidence base for staging CT chest in such cases.
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