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__NOTOC__
__NOTOC__
{{Renal cell carcinoma}}
{{Renal cell carcinoma}}
{{CMG}}; {{AE}}
{{CMG}}
== Overview ==
== Overview ==
A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.


=== Study of choice ===
==Needle Biopsy==
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
Needle biopsy should always be performed when the finding of a renal mass is detected on imaging. CT or MRI guided needle biopsy distinguishes between different subgroups of renal cell carcinoma and identifies management: active surveillance, surgery, or medical therapy.<ref name="pmid23665399">{{cite journal| author=Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH et al.| title=Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline. | journal=J Urol | year= 2013 | volume= 190 | issue= 2 | pages= 407-16 | pmid=23665399 | doi=10.1016/j.juro.2013.04.121 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23665399  }} </ref> The sensitivity and specificity of needle biopsy are very high. The rate of biopsy-related complications, including biopsy-associated seeding, is considered very low.<ref name="pmid23665399">{{cite journal| author=Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH et al.| title=Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline. | journal=J Urol | year= 2013 | volume= 190 | issue= 2 | pages= 407-16 | pmid=23665399 | doi=10.1016/j.juro.2013.04.121 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23665399  }} </ref>
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of the investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].  
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for [disease name] ====
{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center"
{|
|+ '''''Histopathological Findings in Renal Cell Carcinoma<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. |journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 |doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid19269025">{{cite journal| author=Rini BI, Campbell SC, Escudier B| title=Renal cell carcinoma. | journal=Lancet | year= 2009 | volume= 373 | issue= 9669 | pages= 1119-32 | pmid=19269025 | doi=10.1016/S0140-6736(09)60229-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19269025  }} </ref>'''''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Type''' || style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Characteristic Features'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| bgcolor="#DCDCDC"|'''Conventional (Clear Cell)''' ||*Nests of tumor cells that are compacted near each other<br>*Clear cytoplasm<br>*Delicate vasculature that separates the cytoplasm<br>*Varying architectural patterns, such as solid, alveolar, or acinar
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| bgcolor="#DCDCDC"|'''Papillary''' || *Papillae, tubulopapillae, and tubules that are present in differing percentages<br>*Type I generally has papillae lined with only 1 layer of cancer cells, pale cytoplasm, and small oval nuclei<br>*Type II generally are more heterogeneous tumors that have pseudostratification with large, spherical nuclei and distinct nucleoli
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| bgcolor="#DCDCDC"|'''Chromophobe''' || *Large polygonal cells<br>*Finely reticulated cytoplasm that may be eosinophilic<br>*Distinct cell borders<br>*Atypical nuclei with perinuclear halo
 
|}
|}
<small> ✔= The best test based on the feature </small>
<sup><center>Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.''N Engl J Med''. 2005; 353:2477-90 & Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. ''Lancet''. 2009; 373(9669):1119-32</center></sup>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 


==References==
==References==

Latest revision as of 14:35, 13 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.

Diagnostic Study of Choice

A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.

Needle Biopsy

Needle biopsy should always be performed when the finding of a renal mass is detected on imaging. CT or MRI guided needle biopsy distinguishes between different subgroups of renal cell carcinoma and identifies management: active surveillance, surgery, or medical therapy.[1] The sensitivity and specificity of needle biopsy are very high. The rate of biopsy-related complications, including biopsy-associated seeding, is considered very low.[1]

Histopathological Findings in Renal Cell Carcinoma[2][3]
Type Characteristic Features
Conventional (Clear Cell) *Nests of tumor cells that are compacted near each other
*Clear cytoplasm
*Delicate vasculature that separates the cytoplasm
*Varying architectural patterns, such as solid, alveolar, or acinar
Papillary *Papillae, tubulopapillae, and tubules that are present in differing percentages
*Type I generally has papillae lined with only 1 layer of cancer cells, pale cytoplasm, and small oval nuclei
*Type II generally are more heterogeneous tumors that have pseudostratification with large, spherical nuclei and distinct nucleoli
Chromophobe *Large polygonal cells
*Finely reticulated cytoplasm that may be eosinophilic
*Distinct cell borders
*Atypical nuclei with perinuclear halo
Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.N Engl J Med. 2005; 353:2477-90 & Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet. 2009; 373(9669):1119-32

References

  1. ↑ 1.0 1.1 Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH; et al. (2013). "Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline". J Urol. 190 (2): 407–16. doi:10.1016/j.juro.2013.04.121. PMID 23665399.
  2. ↑ Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  3. ↑ Rini BI, Campbell SC, Escudier B (2009). "Renal cell carcinoma". Lancet. 373 (9669): 1119–32. doi:10.1016/S0140-6736(09)60229-4. PMID 19269025.

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