Staging CT chest for cT1a renal masses: Does it change management?

Our plain-English summary of Staging CT chest for cT1a renal masses: Does it change management?, by S. Ilangovan, H. Warren, F. Sordelli, et al (BJUI Compass, 2025).

The study

• Authors: S. Ilangovan, H. Warren, F. Sordelli, T.P. Oo, P.P. Tun, P. Patki, F. Mumtaz, R. Barod, A. Bex, M. Tran
• Journal: BJUI Compass
• Published: 2025;6(9):e70068
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Baseline staging investigations for renal masses invariably include a CT of the chest. However, EAU guidelines have given a weak recommendation that CT chest can be omitted in incidental T1a tumours (≤4 cm) without systemic symptoms, due to the low incidence of pulmonary metastases. This study aimed to assess if a baseline staging CT chest has been clinically useful in a cohort with T1a renal tumours.

Methods: Consecutive patients with solid and cystic cT1a renal tumours were prospectively screened for eligibility to the NEST study (ISRCTN 18156881) at a single tertiary referral centre multidisciplinary team meeting (MDT). Four hundred consecutive eligible patients between 28/05/2019 and 13/01/2021 were included in this study. Electronic records were reviewed retrospectively for follow-up data. Seventeen patients with incomplete follow-up data were excluded.

Results: Of 383 included patients (63% male, median age 65 years, median tumour diameter 2.4 cm), 264 (69%) had a baseline CT chest as part of their clinical staging investigations. No thoracic renal metastases were diagnosed. Abnormalities were reported in 37/264 cases (14%), including indeterminate lung lesions in 32 patients that were deemed benign on further investigations, three synchronous primary lung tumours, one pre-existing mesothelioma and one pleural effusion related to known renal failure.

Conclusion: CT chest is of limited value in clinical staging investigations for cT1a renal tumours and has a negligible impact on subsequent renal tumour management. Rather, it triggered further investigations and follow-up for 14% of incidentalomas and ultimately detected concurrent incidental primary lung tumours in 1% of patients.

© 2025 The Author(s). BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.

In plain English

This study, from a London kidney cancer centre, asked whether staging chest CT changed care for small kidney tumours (clinical stage T1a, 4 cm or less). The authors identified four hundred patients between May 2019 and January 2021 and reviewed their records retrospectively. Seventeen were excluded for incomplete follow-up, leaving 383. Of these, 264 (69%) had a baseline chest CT, and 156 of the 264 (59%) needed a separate hospital visit for it. No kidney cancer that had spread to the chest was found. Abnormalities appeared on 37 of the 264 scans (14%), most of them lung nodules later judged benign. Three of the 264 scanned patients (1.1%) had a separate primary lung tumour, which changed management of their kidney tumour. One patient had a mesothelioma that was already known before the scan. The article lists it among pre-existing chest conditions but does not name its exact site, and does not discuss asbestos. The authors concluded that their results support leaving out staging chest CT for these tumours. They noted that their results may be affected by selection bias.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-centre retrospective cohort study: records were reviewed for patients screened for a separate trial (NEST)
• Who was studied: Patients with newly diagnosed solid or cystic cT1a kidney tumours at the Royal Free Hospital Specialist Centre for Kidney Cancer, London. Four hundred were identified between May 2019 and January 2021; 17 were excluded for incomplete follow-up, leaving 383 (63% male, median age 65, median tumour diameter 24 mm).
• Exposure: No asbestos exposure was studied. The study examined the use and results of baseline staging CT scans of the chest.
• Main results:
  • 264 of 383 patients (69%) had a baseline staging chest CT
  • Of the 264 patients with a baseline chest CT, 156 (59%) needed a separate additional visit to radiology for it
  • No metastases from kidney cancer were found. Three of the 264 patients who had a chest CT (1.1%) had synchronous primary lung tumours.
  • 37 of the 264 chest CTs (14%) showed abnormalities, leading to further interval imaging in 19 patients (51%)
  • 8 patients were referred to a lung MDT. Of the 6 who had invasive investigations, 3 had benign nodules and 3 had synchronous primary lung tumours.
  • Among the other findings, 32 patients had benign lung nodules, 1 had pleural effusions related to known end-stage renal failure, and 1 had a pre-existing mesothelioma, listed in Table 1 under pre-existing thoracic pathology
  • In all three patients with lung tumours, finding the lung cancer changed the management of their kidney tumour
• The authors' conclusion: The authors concluded that their results support the EAU recommendation that staging chest CT for metastases could be omitted in patients with cT1a kidney tumours. They also noted that the synchronous lung cancers point to possible value in targeted lung cancer screening of high-risk groups.
• Limitations the authors state:
  • Follow-up surveillance imaging was not systematically reviewed for patients who did not have a baseline chest CT
  • Patients who had a staging chest CT may have differed from those who did not, so the results are subject to selection bias
  • A single large tertiary referral centre may not represent other centres and settings
  • The study period overlapped with the COVID-19 pandemic, so some incidental findings may have been COVID-19-related

Topics

Medical terms in this study, explained in our Lexicon: Staging, Multidisciplinary Team, Mesothelioma, Pleural Effusion.

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