Contemporary imaging techniques have contributed significantly to the detection and staging of renal cell carcinoma. The accuracy of current imaging methods in detecting renal cell carcinoma approaches 100%.<sup>59 Zagoria R.J., Wolfman N.T., Karstaedt N. , e al. CT features of renal cell carcinoma with emphasis on relation to tumor size Invest Radiol 1990 ;  25 : 261  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Almost as many new renal cell carcinomas are being detected incidentally as are being found in patients investigated because of hematuria or flank pain.<sup>36 Lieber M.M. Renal cell carcinoma: New developments Mayo Clin Proc 1985 ;  60 : 715

Cliccare qui per andare alla sezione Riferimenti</sup> The initial detection of renal masses can be achieved by many imaging methods, including excretory urography,<sup>10 Davidson A.J., Hartman D.S. Staging strategies for tumors of the kidney, adrenal gland, and retroperitoneum CA Cancer J Clin 1987 ;  37 : 151

Cliccare qui per andare alla sezione Riferimenti</sup> ultrasound (US), or CT scan. Once found, however, the main objective is to determine the pathologic nature and stage of a renal mass.<sup>10 Davidson A.J., Hartman D.S. Staging strategies for tumors of the kidney, adrenal gland, and retroperitoneum CA Cancer J Clin 1987 ;  37 : 151

Cliccare qui per andare alla sezione Riferimenti</sup>

Survival with renal cell carcinoma depends on the local extent of the primary tumor, presence or absence of distant metastases,<sup>41 Patel S.K., Stack C.M., Turner D.A. Magnetic resonance imaging in staging of renal cell carcinoma 1987 ;  7 : 703

Cliccare qui per andare alla sezione Riferimenti</sup> and tumor histology. The stage at the time of the initiation of treatment correlates directly with prognosis.<sup>2 Bennington J.L., Beckwith J.B. Atlas of Tumor Pathology Tumors of the Kidney, Renal Pelvis, and Ureter, 2nd fascicle 12 Washington, DC: Armed Forces Institute of Pathology (1975).  190

Cliccare qui per andare alla sezione Riferimenti</sup> In patients with well-defined tumors with no evidence of capsular, vascular, or lymph node involvement, survival depends on tumor size and grade.<sup>4 Birnbaum B.A., Bosniak M.A., Megibow A.J. , e al. Observations on the growth of renal neoplasms Radiology 1990 ;  176 : 695-701

Cliccare qui per andare alla sezione Riferimenti</sup> Evidence shows that CT scan findings can suggest the histologic grade<sup>4 Birnbaum B.A., Bosniak M.A., Megibow A.J. , e al. Observations on the growth of renal neoplasms Radiology 1990 ;  176 : 695-701

Cliccare qui per andare alla sezione Riferimenti</sup> in some cases. Radiotherapy and chemotherapy have little effect on renal cell carcinoma,<sup>11 DeKernion J.B., Mukamel E. Selection of initial therapy for renal cell carcinoma Cancer 1987 ;  60 : 539-546  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> making surgery the only effective treatment. Surgical planning largely depends on preoperative imaging delineation of disease extent. Therefore, establishing an accurate stage of the tumor at the earliest possible opportunity is important for properly managing the primary neoplasm and providing accurate prognostic information for the patient. The best overall imaging approach should determine stage and extent of disease accurately, especially identifying distant metastases and adjacent organ invasion, either of which indicates incurable disease.

Many different staging systems have been developed by different authorities. The first staging system for renal cell carcinoma was developed by Flocks and Kadesky in 1958, which subsequently was modified by Robson and associates in 1963,<sup>43 Robson C.J., Churchill B.M., Anderson W. The results of radical nephrectomy for renal cell carcinoma J Urol 1969 ;  101 : 297

Cliccare qui per andare alla sezione Riferimenti</sup> and this remains one of the primary staging systems in use today (Table 1). The TNM classification proposed by the American Joint Committee for Cancer Staging and End Results Reporting has not gained wide acceptance, possibly because of the greater number of subgroups involved,<sup>41 Patel S.K., Stack C.M., Turner D.A. Magnetic resonance imaging in staging of renal cell carcinoma 1987 ;  7 : 703

Cliccare qui per andare alla sezione Riferimenti</sup> and the Robson staging system is used in the imaging literature to standardize staging accuracy rates.

Many imaging techniques are available to help stage renal cell carcinoma, including CT scan, MR imaging, US, renal angiography (RA), digital subtraction angiography (DSA), and inferior venacavography (IVCG). The choice of which to use often depends on local physician preferences, patient risk factors, the strengths of each of these imaging methods, and the stage of a tumor in question.

This article describes the features of each of these imaging methods in relation to staging renal cell carcinoma. The discussion centers on advantages, limitations, technical aspects, typical findings, accuracy rates at each stage and overall, and pitfalls associated with each method. The greatest attention is given to CT scan and MR imaging because they are the primary imaging methods with which current staging is accomplished. Finally, the authors conclude with a suggested overall approach to staging renal cell carcinoma, incorporating all methods in a proper order.