Diagnosis and Treatment of Renal Neoplasm—A Fresh Approach
Bruce H. Stewart, M.D.
Department of Urology
Thomas F. Meaney, M.D.
Department of Hospital Radiology
DIAGNOSIS of renal tumors in the past has been made principally on the basis of pyelography—either intravenous or retrograde. When there was definite radiographic evidence of a tumor deformity, renal exploration by the flank approach was usually advised. When a solid tumor was encountered, nephrectomy was performed; when a cyst was present, it usually was unroofed and drained.
Although this approach provided effective treatment in many cases, it nevertheless had several inherent drawbacks: (1) The tumor often has to be fairly well advanced before unequivocal pyelographic changes are evident, thereby causing a needless delay in establishing the diagnosis of neoplasm. (2) A cyst cannot be differentiated from carcinoma by pyelographic evidence alone, and therefore an operation usually was necessary to confirm the diagnosis. (3) When the mass proved to be malignant, extensive manipulation and exposure of the tumor was sometimes necessary before the diagnosis could be established and the renal pedicle secured. Undoubtedly, tumor cells were excessively disseminated into the bloodstream in many of these cases. (4) When exposure of the kidney revealed no obvious neoplasm, either the kidney was widely opened and biopsied, or removed entirely. Normal kidneys often were thus unnecessarily traumatized or even lost. (5) The presence of hepatic metastases, which profoundly alters prognosis and treatment, could not be readily determined.
Aortography has long been available for better preoperative delineation of the true nature of renal masses,1, 2 but relative lack of accuracy3–6 and not insignificant morbidity7–9 have prevented its routine use in this. . .