医学
放射科
适当的使用标准
适宜性标准
肾肿块
活检
无症状的
不确定
肾
外科
内科学
肾切除术
数学
纯数学
作者
Marta E. Heilbrun,Erick M. Remer,David D. Casalino,Michael D. Beland,Jay T. Bishoff,M. Donald Blaufox,Courtney A. Coursey,Stanley Goldfarb,Howard J. Harvin,Paul Nikolaidis,Glenn M. Preminger,Steven S. Raman,Anik V. Sahni,Raghunandan Vikram,Robert M. Weinfeld
标识
DOI:10.1016/j.jacr.2014.12.012
摘要
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. An indeterminate renal mass is one that cannot be diagnosed confidently as benign or malignant at the time it is discovered. CT, ultrasonography, and MRI of renal masses with fast-scan techniques and intravenous (IV) contrast are the mainstays of evaluation. Dual-energy CT, contrast-enhanced ultrasonography, PET/CT, and percutaneous biopsy are all technologies that are gaining traction in the characterization of the indeterminate renal mass. In cases in which IV contrast cannot be used, whether because of IV contrast allergy or renal insufficiency, renal mass classification with CT is markedly limited. In the absence of IV contrast, ultrasonography, MRI, and biopsy have some advantages. Owing to the low malignant and metastatic potential of small renal cell carcinomas (≤4 cm in diameter), active surveillance is additionally emerging as a diagnostic strategy for patients who have high surgical risk or limited life expectancy. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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