Renal Cell Carcinoma Follow-Up - Is it Time to Abandon Ultrasound?

Background: We wished to compare the efficacy of ultrasound versus intravenous contrast-enhanced computed tomography (CT) for detecting recurrent renal cell carcinoma (RCC) by identifying patients presenting with such tumor burden and to evaluate the utility of these imaging modalities in these circumstances. Methods: Patients who developed local and/or distant recurrences following surgical intervention for RCC were identified. The imaging regimen utilized during post-operative surveillance was analyzed to determine whether recurrent disease was identifiable on ultrasound or CT or both. Results: Of the 22 patients with recurrent RCC, 16 had previously undergone radical nephrectomy and 6 had undergone partial nephrectomy. Median duration to RCC recurrence was 28.5 months (range 2-66 months). Fourteen patients (64%) underwent ultrasound during their follow-up surveillance protocol and 1 case of disease recurrence was detected by ultrasound before subsequent con-frmation with CT. All 22 patients underwent CT as a routine component of their follow-up surveillance protocol and all recurrences were detected by this modality. Six patients had recurrence in their ipsilateral kidney after partial nephrec-tomy - five had undergone ultrasound in their surveillance protocol and this modality failed to detect a recurrence in four of these patients. Conclusion: Ultrasound is inferior to CT for detecting recurrent RCC. CT should be recognized as the standard diagnostic modality during post-operative surveillance, in contradiction to what is recommended in many guidelines.