Clinical significance in incidentally detected renal cell carcinoma

Kim, Ki Dong; Woo, Young Nam

Abstract

Between January 1980 and December 1989. 76 cases of renal cell carcinoma were treated by radical nephrectomy at Department of Urology. Hanyang University Hospital. Among them 65 cases were followed up at least 12 months and 16 cases (24.6%) were diagnosed incidentally. The ratio or incidentally detected renal cell carcinoma has been increasing steadily in the past decade. Two of 24 patients (8%) were discovered incidentally between 1980 and 1984 compared with 14 of 41(34%) between 1985 and 1989. Eleven of these cases(68.7%) were detected by ultrasound. three by computerized tomography. and two by excretory urography. Nine of these cases were unexpectedly found by chance during examination for health check up. while others were found during examination for other diseases. The stage and grade of these incidental carcinoma were significantly lower than those of symptomatic carcinoma. respectively (p<0.01. p<0.05). Primary tumor size was also significantly smaller in the incidental carcinoma(p<0.05). The S-year survival rates for the incidental and symptomatic carcinomas after radical nephrectomy were 93.7% and 53.6%. respectively (p<0.001). These data have shown an increase in the proportion of incidentally diagnosed cases. Ultrasonography is a useful tool to detect low stage asymptomatic renal cell carcinoma and has led to earlier diagnosis, lower stage and possible longer survival in patients with incidentally discovered renal cell carcinomas compared with patients where the diagnosis was suspected. These results supported the rationale for the efforts to detect renal cell carcinoma at health check-up or the attention to renal lesions on examination for unrelated diseases.