How accurate is ultrasonography in the diagnosis of renal cell carcinoma (RCC)?

Answer

Confidence in tumor detection is increased as lesions increase in size. Larger lesions are usually more heterogeneous and more often hypoechoic. In a reported series, a detection rate of 85% was seen in lesions larger than 3 cm.^[51]A detection rate of less than 60% was seen in lesions smaller than 2 cm.

Confidence also increases if lesions are solid, lobulated, or well differentiated from the normal parenchyma; if they have poor through-transmission; and if they show flow with CEUS.

False-positive results are rare because US is seldom the sole imaging modality used prior to intervention.

A prominent column of Bertin or fetal lobulation may mimic a solid renal mass and can be resolved with a dedicated CT or MRI examination.

False-negative findings can occur if care is not taken to fully examine all aspects of the kidney, because US is highly operator-dependent. False-negative results are also possible if the RCC is small, is isoechoic to the parenchyma, and/or is not contour deforming.

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Guzzo TJ, Pierorazio PM, Schaeffer EM, Fishman EK, Allaf ME. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patients with renal cell carcinoma. J Urol. 2009 Feb. 181(2):486-90; discussion 491. [Medline].
Bulnes Vázquez V, Alvarez-Múgica M, Fernández Gómez JM, Nava Tomás E, Jalón Monzón A, Meilán Martínez A. [Clinicopathologic features of renal cell carcinoma incidentally detected through radiological studies]. Actas Urol Esp. 2008 Nov-Dec. 32(10):976-84. [Medline].
Gabr AH, Gdor Y, Roberts WW, Wolf JS Jr. Radiographic surveillance of minimally and moderately complex renal cysts. BJU Int. 2009 Apr. 103(8):1116-9. [Medline].
Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2018 Sep 19. [Medline]. [Full Text].
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018 Jan. 68 (1):7-30. [Medline]. [Full Text].
American Cancer Society. Cancer reference information, detailed guide: kidney cancer staging. American Cancer Society Web site. Available at: http://www.cancer.org/Cancer/KidneyCancer/detailedguide/kidney-cancer-adult-staging. Accessed October 28, 2013. [Full Text].
American Cancer Society. Cancer reference information, detailed guide: kidney cancer statistics. American Cancer Society Web site. Available at: http://www.cancer.org/Cancer/KidneyCancer/DetailedGuide/kidney-cancer-adult-key-statistics. Accessed October 28, 2013. [Full Text].
Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, et al. ACR Appropriateness Criteria Renal Cell Carcinoma Staging. J Am Coll Radiol. 2016 May. 13 (5):518-25. [Medline]. [Full Text].
Sankineni S, Brown A, Cieciera M, Choyke PL, Turkbey B. Imaging of renal cell carcinoma. Urol Oncol. 2015 Jun 17. [Medline].
Chiarello MA, Mali RD, Kang SK. Diagnostic Accuracy of MRI for Detection of Papillary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol. 2018 Oct. 211 (4):812-821. [Medline].
Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, et al. Imaging in Suspected Renal-Cell Carcinoma: Systematic Review. Clin Genitourin Cancer. 2018 Aug 11. [Medline].
Oliva MR, Glickman JN, Zou KH, Teo SY, Mortelé KJ, Rocha MS, et al. Renal cell carcinoma: t1 and t2 signal intensity characteristics of papillary and clear cell types correlated with pathology. AJR Am J Roentgenol. 2009 Jun. 192(6):1524-30. [Medline].
Taouli B, Thakur RK, Mannelli L, Babb JS, Kim S, Hecht EM, et al. Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology. 2009 May. 251(2):398-407. [Medline].
Beddy P, Genega EM, Ngo L, Hindman N, Wei J, Bullock A, et al. Tumor Necrosis on Magnetic Resonance Imaging Correlates With Aggressive Histology and Disease Progression in Clear Cell Renal Cell Carcinoma. Clin Genitourin Cancer. 2013 Oct 19. [Medline].
Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS. Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology. 2013 May. 267(2):444-53. [Medline].
Shinagare AB, Vikram R, Jaffe C, Akin O, Kirby J, Huang E, et al. Radiogenomics of clear cell renal cell carcinoma: preliminary findings of The Cancer Genome Atlas-Renal Cell Carcinoma (TCGA-RCC) Imaging Research Group. Abdom Imaging. 2015 Aug. 40 (6):1684-92. [Medline].
Bagheri MH, Ahlman MA, Lindenberg L, Turkbey B, Lin J, Cahid Civelek A, et al. Advances in medical imaging for the diagnosis and management of common genitourinary cancers. Urol Oncol. 2017 Jul. 35 (7):473-491. [Medline]. [Full Text].
Wang ZJ, Coakley FV, Fu Y, Joe BN, Prevrhal S, Landeras LA, et al. Renal cyst pseudoenhancement at multidetector CT: what are the effects of number of detectors and peak tube voltage?. Radiology. September 2008. 248:910-916. [Medline].
Bae KT, Heiken JP, Siegel CL, Bennett HF. Renal cysts: is attenuation artifactually increased on contrast- enhanced CT images?. Radiology. 2000 Sep. 216(3):792-6. [Medline].
Birnbaum BA, Jacobs JE, Ramchandani P. Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases. Radiology. 1996 Sep. 200(3):753-8. [Medline].
Coulam CH, Sheafor DH, Leder RA, et al. Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT. AJR Am J Roentgenol. 2000 Feb. 174(2):493-8. [Medline].
Heneghan JP, Spielmann AL, Sheafor DH, et al. Pseudoenhancement of simple renal cysts: a comparison of single and multidetector helical CT. J Comput Assist Tomogr. 2002 Jan-Feb. 26(1):90-4. [Medline].
Kim JK, Park SY, Shon JH, Cho KS. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology. 2004 Mar. 230(3):677-84. [Medline].
Kopka L, Fischer U, Zoeller G, et al. Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation of renal lesions and preoperative staging of renal cell carcinoma. AJR Am J Roentgenol. 1997 Dec. 169(6):1573-8. [Medline].
Lockhart ME, Smith JK. Technical considerations in renal CT. Radiol Clin North Am. 2003 Sep. 41(5):863-75. [Medline].
Macari M, Bosniak MA. Delayed CT to evaluate renal masses incidentally discovered at contrast-enhanced CT: demonstration of vascularity with deenhancement. Radiology. 1999 Dec. 213(3):674-80. [Medline].
Maki DD, Birnbaum BA, Chakraborty DP, et al. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology. 1999 Nov. 213(2):468-72. [Medline].
Scatarige JC, Sheth S, Corl FM, Fishman EK. Patterns of recurrence in renal cell carcinoma: manifestations on helical CT. AJR Am J Roentgenol. 2001 Sep. 177(3):653-8. [Medline].
Siegel CL, Fisher AJ, Bennett HF. Interobserver variability in determining enhancement of renal masses on helical CT. AJR Am J Roentgenol. 1999 May. 172(5):1207-12. [Medline].
Suh M, Coakley FV, Qayyum A, et al. Distinction of renal cell carcinomas from high-attenuation renal cysts at portal venous phase contrast-enhanced CT. Radiology. 2003 Aug. 228(2):330-4. [Medline].
Szolar DH, Kammerhuber F, Altziebler S, et al. Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (< 3-cm) renal masses. Radiology. 1997 Jan. 202(1):211-7. [Medline].
Takebayashi S, Hidai H, Chiba T, et al. Using helical CT to evaluate renal cell carcinoma in patients undergoing hemodialysis: value of early enhanced images. AJR Am J Roentgenol. 1999 Feb. 172(2):429-33. [Medline].
Zeman RK, Zeiberg A, Hayes WS, et al. Helical CT of renal masses: the value of delayed scans. AJR Am J Roentgenol. 1996 Sep. 167(3):771-6. [Medline].
Juluru K, Vogel-Claussen J, Macura KJ, Kamel IR, Steever A, Bluemke DA. MR Imaging in Patients at Risk for Developing Nephrogenic Systemic Fibrosis: Protocols, Practices, and Imaging Techniques to Maximize Patient Safety. Radiographics. Epub ahead of print:[Medline].
Hill KL, Lipson AC, Sheehan JM. Brain magnetic resonance imaging changes after sorafenib and sunitinib chemotherapy in patients with advanced renal cell and breast carcinoma. J Neurosurg. 2009 Feb 6. [Medline].
Wu B, Peng WJ, Gu YJ, Yang TX, Jiang ZX, Zhang HL, et al. [MR imaging features of different renal cell carcinoma subtypes.]. Zhonghua Zhong Liu Za Zhi. 2008 Nov. 30(11):825-30. [Medline].
Sun MR, Ngo L, Genega EM, Atkins MB, Finn ME, Rofsky NM, et al. Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes--correlation with pathologic findings. Radiology. 2009 Mar. 250(3):793-802. [Medline].
Choyke PL. Detection and staging of renal cancer. Magn Reson Imaging Clin N Am. 1997 Feb. 5(1):29-47. [Medline].
Narumi Y, Hricak H, Presti JC Jr, et al. MR imaging evaluation of renal cell carcinoma. Abdom Imaging. 1997 Mar-Apr. 22(2):216-25. [Medline].
Outwater EK, Bhatia M, Siegelman ES, et al. Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images. Radiology. 1997. 205:103-7. [Medline].
Scialpi M, Di Maggio A, Midiri M, et al. Small renal masses: assessment of lesion characterization and vascularity on dynamic contrast-enhanced MR imaging with fat suppression. AJR Am J Roentgenol. 2000 Sep. 175(3):751-7. [Medline].
Yoshimitsu K, Honda H, Kuroiwa T. MR detection of cytoplasmic fat in clear cell renal cell carcinoma utilizing chemical shift gradient-echo imaging. J Magn Res Imag. 1999. 9:579-85. [Medline].
Jhaveri KS, Elmi A, Hosseini-Nik H, Hedgire S, Evans A, Jewett M, et al. Predictive Value of Chemical-Shift MRI in Distinguishing Clear Cell Renal Cell Carcinoma From Non-Clear Cell Renal Cell Carcinoma and Minimal-Fat Angiomyolipoma. AJR Am J Roentgenol. 2015 Jul. 205 (1):W79-86. [Medline].
Tamai H, Takiguchi Y, Oka M. Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med. 2005 Dec. 24(12):1635-40.
Roy C, Gengler L, Sauer B, Lang H. [Role of contrast enhanced US in the evaluation of renal tumors]. J Radiol. 2008 Nov. 89(11 Pt 1):1735-44. [Medline].
Kier R, Taylor KJ, Feyock AL, Ramos IM. Renal masses: characterization with Doppler US. Radiology. 1990 Sep. 176(3):703-7. [Medline].
Kuijpers D, Jaspers R. Renal masses: differential diagnosis with pulsed Doppler US. Radiology. 1989 Jan. 170(1 Pt 1):59-60. [Medline].
Ramos IM, Taylor KJ, Kier R, et al. Tumor vascular signals in renal masses: detection with Doppler US. Radiology. 1988 Sep. 168(3):633-7. [Medline].
Vallancien G, Torres LO, Gurfinkel E. Incidental detection of renal tumours by abdominal ultrasonography. Eur Urol. 1990. 18(2):94-6. [Medline].
Tamas-Szora A, Socaciu M, Crisan N, Dobrota F, Prundus P, Bungardean C, et al. Investigation of Renal Cell Carcinoma by Contrast-Enhanced Ultrasound- Predictive Value of Time Intensity Curve Analysis in Establishing Local Tumor Invasion and Stage: A Pilot Study. Urol J. 2015 Jul 1. 12 (3):2173-81. [Medline].
Warshauer DM, McCarthy SM, Street L. Detection of renal masses: sensitivities and specificities of excretory urography/linear tomography, US, and CT. Radiology. 1988 Nov. 169(2):363-5.
Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic Renal Cell Carcinoma: Radiologic Findings and Assessment of Response to Targeted Antiangiogenic Therapy by Using Multidetector CT. Radiographics. 2013 Oct. 33(6):1691-716. [Medline].

Media Gallery

Case 1. Large renal cell carcinoma. Three-minute tomogram.
Case 1. Large renal cell carcinoma. Delayed intravenous urographic image.
Case 1. Large renal cell carcinoma. Contrast-enhanced computed tomography (CT) scan.
Case 2. Large renal cell carcinoma. Delayed tomogram.
Case 2. Large renal cell carcinoma. Sonogram.
Case 2. Large renal cell carcinoma. Contrast-enhanced CT scan.
Case 3. Small left renal cell carcinoma is subtle on this intravenous urographic image.
Case 3. Small renal cell carcinoma. Tomogram.
Case 3. Small renal cell carcinoma. Contrast-enhanced CT scan.
Case 4. Renal cell carcinoma. Dedicated renal CT scan. Before contrast enhancement, right kidney.
Case 4. Renal cell carcinoma. Dedicated renal CT scan obtained before contrast enhancement. Right kidney has an attenuation measurement of 45.7 HU.
Case 4. Renal cell carcinoma. Contrast-enhanced dedicated renal CT scan. Right kidney.
Case 4. Renal cell carcinoma. Contrast-enhanced dedicated renal CT scan with an attenuation measurement of 101.7 HU.
Case 5. Typical renal cell carcinoma. CT scan obtained before contrast enhancement has an attenuation measurement of 33.9 HU.
Case 5. Typical renal cell carcinoma. Contrast-enhanced CT scan has an attenuation measurement of 75.8 HU.
Case 6. Multifocal renal cell carcinoma in a patient with Von Hippel-Lindau disease. Contrast-enhanced CT scan.
Case 6. Multifocal renal cell carcinoma in a patient with Von Hippel Lindau disease. Patient had already undergone a right nephrectomy. Contrast-enhanced CT scan.
Case 7. Multifocal renal cell carcinoma in patient presenting with palpable mass. Nonenhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Nonenhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Contrast-enhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Contrast-enhanced CT scan.
Case 8. Cystic renal cell carcinoma. Nonenhanced CT scan with an attenuation measurement of 25.8 HU.
Case 8. Cystic renal cell carcinoma. Contrast-enhanced CT scan with an attenuation measurement of 47.1 HU.
Case 9. Cystic renal cell carcinoma. Contrast-enhanced CT scan with an enhancing rim of soft tissue.
Case 9. Renal cell carcinoma. Metastatic lesion to the thoracic spine. Loss of the anterior cortex of a midthoracic vertebral body, with the suggestion of an anterior soft-tissue mass is shown.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the mediastinal nodes and left rib.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the liver.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the right iliac bone.
Case 11. Stage 3a renal cell carcinoma. Patient receiving long-term dialysis with a proven right-sided renal cell carcinoma. Image shows inferior vena cava invasion.
Case 11. Stage 3a renal cell carcinoma. Right atrial extension of a tumor thrombus.
Case 12. Recurrent renal cell carcinoma. Status post–right nephrectomy with local recurrence (arrow) in nephrectomy bed. Contrast-enhanced CT scan.
Case 13. Recurrent renal cell carcinoma. Status post–left nephrectomy with metastatic disease to mediastinal nodes. Contrast-enhanced CT scan.
Case 13. Recurrent renal cell carcinoma. Status post left nephrectomy with metastatic disease to the contralateral adrenal gland.
Case 14. Recurrent renal cell carcinoma. Status post right nephrectomy with metastatic disease to the ipsilateral psoas muscle and liver.
Case 14. Recurrent renal cell carcinoma. Status post right nephrectomy with metastatic disease to the liver.
Case 15. Renal cell carcinoma. Angiomyolipoma. Contrast-enhanced CT scan.
Case 16. Left renal cell carcinoma in patient who underwent prior right nephrectomy for renal cell carcinoma. T1-weighted axial magnetic resonance image (MRI).
Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI with renal vein invasion and extension of tumor into the inferior vena cava.
Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI obtained above the level in image 38. Tumor extends into the intrahepatic inferior vena cava.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted coronal MRI.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted axial MRI before contrast enhancement.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted contrast-enhanced axial MRI.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T2-weighted MRI.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted MRI before contrast enhancement.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted contrast-enhanced MRI.
Case 20. Renal cell carcinoma. Oncocytoma. T2-weighted axial MRI.
Case 20. Renal cell carcinoma. Oncocytoma. Dynamic enhanced coronal T1-weighted MRI.
Case 21. Right renal cell carcinoma. Ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained prior to the intravenous administration of ultrasonographic contrast agent.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained after the intravenous administration of ultrasonographic contrast agent.
Case 22. Left renal cell carcinoma. Ultrasonogram.
Case 22. Left renal cell carcinoma. Nonenhanced CT scan.
Case 22. Left renal cell carcinoma. Contrast-enhanced CT scan.
Case 22. Left renal cell carcinoma. Anterior component of circumaortic renal vein is normal.
Case 22. Left renal cell carcinoma. Posterior component of circumaortic renal vein is normal.
Case 23. Renal cell carcinoma. Complex cyst. Nonenhanced CT scan.
Case 23. Renal cell carcinoma. Complex cyst. Contrast-enhanced CT scan.
Case 23. Renal cell carcinoma. Complex cyst. Ultrasonogram with low-level echoes.
Case 23. Renal cell carcinoma. Complex cyst. Doppler ultrasonogram shows no internal flow.
Case 24 CT axial image from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney.
Case 24 CT axial image slightly lower from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney.
Case 24 Volume rendered image from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney. The tumor has been colored to show relationship to the multiple renal arteries (two on the left and two on the right, one of which comes from below from the iliac artery).

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How accurate is ultrasonography in the diagnosis of renal cell carcinoma (RCC)?

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