Editing Kidney Cancer: Diagnosis and Evaluation (section)

=== Metastasis Staging ===

* '''Chest x-ray''' in patients with suspected renal malignancy
** Not indicated in patients with suspected or confirmed benign renal masses
**'''Chest is most common site of visceral metastasis'''
** <span style="color:#ff0000">'''Indications for CT chest (3):[https://pubmed.ncbi.nlm.nih.gov/28479239/]'''</span>
**#<span style="color:#ff0000">'''Pulmonary symptoms'''</span>
**#<span style="color:#ff0000">'''Abnormal CXR'''</span>
**#<span style="color:#ff0000">'''High-risk disease, defined by (5):'''</span>
**##<span style="color:#ff0000">'''Presence of thrombi'''</span>
**##<span style="color:#ff0000">'''Presumed adenopathy'''</span>
**##<span style="color:#ff0000">'''Larger tumor size'''</span>
**##<span style="color:#ff0000">'''Infiltrative appearance'''</span>
**##<span style="color:#ff0000">'''Extensive tumor necrosis'''</span>
* Bone scan
** Should be reserved primarily for patients with bone pain or elevated alkaline phosphatase
* Brain imaging for those with neurologic symptoms
* Positron emission tomography (PET)
** Has been investigated for patients with high risk of metastatic RCC, with most studies showing good specificity but suboptimal sensitivity.
** '''Currently, PET scan has no role in the routine evaluation or staging of RCC.'''