In a retrospective analysis of 221 patients with pT1-3N0M0 RCC, only 0.85% of the follow-up chest radiographs detected pulmonary metastases in asymptomatic patients [28]. The yield of a chest radiograph increased to 1.9% when used in patients with intermediate-risk (T2) or high-risk (T3) tumors. In more than half of the patients, pulmonary metastases were detected when patients became symptomatic outside of the routine follow- up. In a second retrospective analysis of 258 patients who had undergone resection or ablation for low-risk (T1a) RCC, pulmonary metastases developed in 3 patients (1.2%), but in only 1 patient (0.4%) was this metastasis diagnosed with surveillance chest radiographs [27]. In a more recent study, only 2 of 384 patients (0.005%) with T1a RCC were found to have pulmonary metastases after surgical therapy, and in both cases, the pulmonary metastases were not detected by surveillance chest radiographs [24]. In the same study, 10 of 184 patients (5.4%) with T1b RCC had suspicious pulmonary lesions found on surveillance radiography of the chest; only 2 of these patients had biopsy-confirmed pulmonary metastasis. However, according to guidelines from urologic and oncologic societies, a chest radiograph is still the recommended technique for the surveillance of patients with T1a tumors, and this technique is also recommended as an alternative to chest CT for the surveillance of patients with T2 and T3 tumors after an initial negative follow-up chest CT examination [9,11]. This is in part because of concerns about potential false-positive findings with chest CT (ie, intrapulmonary lymph nodes and granulomas) that can lead to further unnecessary and potentially invasive investigations [9,12]. Radiography Abdomen There is no relevant literature regarding the use of abdominal radiographs in the follow-up of patients after surgical excision of RCC, and this method is not recommended by the guidelines [2,9,11].
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. In a retrospective analysis of 221 patients with pT1-3N0M0 RCC, only 0.85% of the follow-up chest radiographs detected pulmonary metastases in asymptomatic patients [28]. The yield of a chest radiograph increased to 1.9% when used in patients with intermediate-risk (T2) or high-risk (T3) tumors. In more than half of the patients, pulmonary metastases were detected when patients became symptomatic outside of the routine follow- up. In a second retrospective analysis of 258 patients who had undergone resection or ablation for low-risk (T1a) RCC, pulmonary metastases developed in 3 patients (1.2%), but in only 1 patient (0.4%) was this metastasis diagnosed with surveillance chest radiographs [27]. In a more recent study, only 2 of 384 patients (0.005%) with T1a RCC were found to have pulmonary metastases after surgical therapy, and in both cases, the pulmonary metastases were not detected by surveillance chest radiographs [24]. In the same study, 10 of 184 patients (5.4%) with T1b RCC had suspicious pulmonary lesions found on surveillance radiography of the chest; only 2 of these patients had biopsy-confirmed pulmonary metastasis. However, according to guidelines from urologic and oncologic societies, a chest radiograph is still the recommended technique for the surveillance of patients with T1a tumors, and this technique is also recommended as an alternative to chest CT for the surveillance of patients with T2 and T3 tumors after an initial negative follow-up chest CT examination [9,11]. This is in part because of concerns about potential false-positive findings with chest CT (ie, intrapulmonary lymph nodes and granulomas) that can lead to further unnecessary and potentially invasive investigations [9,12]. Radiography Abdomen There is no relevant literature regarding the use of abdominal radiographs in the follow-up of patients after surgical excision of RCC, and this method is not recommended by the guidelines [2,9,11].