The Limited Usefulness of Ultrasound Surveillance after Radical and Partial Nephrectomy for Renal Cell Carcinoma.

Abstract

We determined the usefulness of ultrasound compared to cross-sectional imaging in the detection of intra-abdominal recurrences after radical or partial nephrectomy for localized renal cell carcinoma. We performed a retrospective review of 800 patients with clinically localized renal cell carcinoma who had undergone radical or partial nephrectomy between 2008 and 2015. Patients had at minimum 1 year of followup at our institution, at least 1 ultrasound during surveillance and no metastases at time of surgery. Our primary outcome was the rate of diagnosis of abdominal recurrence based on modality of surveillance. Median followup for the entire cohort was 37.5 months (range 12 to 166). Overall 396 and 404 patients underwent radical and partial nephrectomy, respectively, for localized renal cell carcinoma. There were 224 (57%) and 234 (58%) patients in the radical and partial nephrectomy cohorts, respectively, who had 2 or more ultrasounds performed during surveillance. In the radical and partial nephrectomy cohorts a total of 149 (19%) abdominal recurrences were detected, with only 8 (19%) initially detected by ultrasound. On the other hand, 15 (10%) recurrences were missed by a prior negative ultrasound. Furthermore, there were 8 false-positive ultrasound studies that cross-sectional imaging later ruled out. The low yield of ultrasound in the detection of abdominal recurrences after radical or partial nephrectomy for renal cell carcinoma raises questions as to its usefulness in routine surveillance.