One study involving 229 patients with RCC reported that CT had a 100% sensitivity for ipsilateral adrenal involvement in RCC but only a 76% specificity [39]. However, Blakely et al [40] reported a 100% sensitivity and a 94% specificity for CT in identifying adrenal involvement. Similar findings have been reported by other authors. In another study involving 579 patients, CT was reported to have a 100% negative predictive value, a 100% sensitivity, and a 95% specificity for identifying adrenal involvement [41]. Assessment of RCC nodal metastases on CT is limited [42]. This is due to the fact that CT uses size criteria for nodal metastasis (size >1 cm in short-axis), but this leads to underestimation of disease, resulting in false negatives in the presence of micrometastases in nodes <1 cm in size. Furthermore, false positives are also often seen because of the presence of reactive adenopathy, with nodes >1 cm in size. CT is fairly accurate in detecting distant metastases in the abdomen and pelvis. RCC visceral metastases may occur at various organs including liver, pancreas, adrenals, and contralateral kidney. RCC metastases tend to be hypervascular, and some authors have suggested that arterial phase imaging can be useful to accurately detect the extent of distant metastases [43-46]. Although CT of the abdomen with IV contrast is considered in all major guidelines as an adequate method for the staging of RCC, imaging of the pelvis for RCC staging is considered optional in the guidelines [5,13]. There is no relevant literature with high-quality evidence regarding the use of CT of the pelvis in the staging of RCC. Although it is likely that CT pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. CT Chest Chest imaging is indicated in the staging of RCC, given that lungs are one of the most common sites of metastases in RCC [5,13].
Staging of Renal Cell Carcinoma. One study involving 229 patients with RCC reported that CT had a 100% sensitivity for ipsilateral adrenal involvement in RCC but only a 76% specificity [39]. However, Blakely et al [40] reported a 100% sensitivity and a 94% specificity for CT in identifying adrenal involvement. Similar findings have been reported by other authors. In another study involving 579 patients, CT was reported to have a 100% negative predictive value, a 100% sensitivity, and a 95% specificity for identifying adrenal involvement [41]. Assessment of RCC nodal metastases on CT is limited [42]. This is due to the fact that CT uses size criteria for nodal metastasis (size >1 cm in short-axis), but this leads to underestimation of disease, resulting in false negatives in the presence of micrometastases in nodes <1 cm in size. Furthermore, false positives are also often seen because of the presence of reactive adenopathy, with nodes >1 cm in size. CT is fairly accurate in detecting distant metastases in the abdomen and pelvis. RCC visceral metastases may occur at various organs including liver, pancreas, adrenals, and contralateral kidney. RCC metastases tend to be hypervascular, and some authors have suggested that arterial phase imaging can be useful to accurately detect the extent of distant metastases [43-46]. Although CT of the abdomen with IV contrast is considered in all major guidelines as an adequate method for the staging of RCC, imaging of the pelvis for RCC staging is considered optional in the guidelines [5,13]. There is no relevant literature with high-quality evidence regarding the use of CT of the pelvis in the staging of RCC. Although it is likely that CT pelvis may not offer additional information in most patients with early stage RCC, pelvic imaging can be helpful in patients with more advanced RCC, in whom metastatic spread is suspected [47,48]. CT Chest Chest imaging is indicated in the staging of RCC, given that lungs are one of the most common sites of metastases in RCC [5,13].