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Renal Mass and Localized Renal Cancer (2021)
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==== Follow-up schedule ==== ===== Nephrectomy ===== * '''<span style="color:#ff0000">Risk-stratified into (4):''' *# '''<span style="color:#ff0000">Low-risk: pT1 and Grade 1/2''' *# '''<span style="color:#ff0000">Intermediate-risk: pT1 and Grade 3/4, or pT2 any Grade''' *# '''<span style="color:#ff0000">High-risk: pT3 any Grade''' *# '''<span style="color:#ff0000">Very high-risk: pT4 or pN1, or sarcomatoid/rhabdoid dedifferentiation, or macroscopic positive margin''' ** '''If final microscopic surgical margins are positive for cancer, the risk category should be considered at least one level higher''', and increased clinical vigilance should be exercised. * '''<span style="color:#ff0000">Follow-up based on risk stratification''' ** '''<span style="color:#ff0000">See [https://www.auanet.org/documents/Guidelines/PDF/RCC-Follow-Up-Algorithm.pdf Table 1] from original guidelines''' ***'''<span style="color:#ff0000">If low-risk, abdominal and chest imaging at 12, 24, 48 and 60 months''' ***'''<span style="color:#ff0000">If intermediate-risk, abdominal and chest imaging at 6, 12, 24, 36, 48 and 60 months''' * '''Imaging:''' ** '''Abdominal''' *** '''After 2 years, abdominal ultrasound (US) alternating with cross-sectional imaging may be considered in the low- and intermediate-risk groups at physician discretion.''' *** '''After 5 years, informed/shared decision-making should dictate further abdominal imaging.''' ** '''Chest''' *** '''Modality''' **** '''Chest x-ray low- and intermediate-risk groups''' **** '''CT chest for high and very high-risk groups.''' *** '''After 5 years, informed/shared decision-making discussion should dictate further chest imaging and chest x-ray may be utilized instead of chest CT for high and very high-risk groups.''' ===== Thermal ablation ===== * '''If biopsy confirmed malignancy or was non-diagnostic, pre- and post-contrast cross-sectional abdominal imaging should be done within 6 months after TA.''' * '''Subsequent follow-up should be according to the intermediate-risk recommendations (see [https://www.auanet.org/documents/Guidelines/PDF/RCC-Follow-Up-Algorithm.pdf Table 1] from original guidelines)'''
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