The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging of Renal Cell Carcinoma presence of any nodal metastases (N1) and/ or T3 tumor. Stage IV disease is the presence of any distant metastases (M1) and/or presence of T4 tumor. Curative treatment for RCC may be accomplished with surgical resection. Partial nephrectomy is the preferred treatment option for small T1 RCC, especially because it is associated with lower risk of renal failure and cardiovascular mortality compared to radical nephrectomy. However, it has been reported that incidence of complications such as postoperative bleeding and urinary leaks may be high in partial nephrectomy. Hence, urologists carefully select patients for partial nephrectomy using preoperative scoring systems, such as the Preoperative Aspects and Dimensions Used for Anatomic assessment score, Renal Nephrometry Score, and Centrality Index. Although a full description of these scoring systems is beyond the scope of this manuscript, urologists consider various factors for surgical planning including size of the tumor and the number of lesions (such as presence of multiple and/or bilateral tumors). The location of the tumor is another important criteria. Factors such as tumor location in the upper/mid/lower pole of the kidney, tumor location in the anterior versus posterior renal cortex, location in the medial or lateral rim, and presence of exophytic versus endophytic tumor may impact the decision to perform partial nephrectomy.
Staging of Renal Cell Carcinoma. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Staging of Renal Cell Carcinoma presence of any nodal metastases (N1) and/ or T3 tumor. Stage IV disease is the presence of any distant metastases (M1) and/or presence of T4 tumor. Curative treatment for RCC may be accomplished with surgical resection. Partial nephrectomy is the preferred treatment option for small T1 RCC, especially because it is associated with lower risk of renal failure and cardiovascular mortality compared to radical nephrectomy. However, it has been reported that incidence of complications such as postoperative bleeding and urinary leaks may be high in partial nephrectomy. Hence, urologists carefully select patients for partial nephrectomy using preoperative scoring systems, such as the Preoperative Aspects and Dimensions Used for Anatomic assessment score, Renal Nephrometry Score, and Centrality Index. Although a full description of these scoring systems is beyond the scope of this manuscript, urologists consider various factors for surgical planning including size of the tumor and the number of lesions (such as presence of multiple and/or bilateral tumors). The location of the tumor is another important criteria. Factors such as tumor location in the upper/mid/lower pole of the kidney, tumor location in the anterior versus posterior renal cortex, location in the medial or lateral rim, and presence of exophytic versus endophytic tumor may impact the decision to perform partial nephrectomy.