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JAMA Insights
Clinical Update
April 1, 2019

Management of Small Kidney Tumors in 2019

Author Affiliations
  • 1Department of Radiology, New York University School of Medicine, New York
  • 2Department of Population Health, New York University School of Medicine, New York
  • 3Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
  • 4Division of Urologic Oncology, Department of Urology, NYU Langone Health, New York
JAMA. 2019;321(16):1622-1623. doi:10.1001/jama.2019.1672

The management of incidentally discovered kidney tumors has changed recently because of improved understanding of their natural history and longer cancer-related survival. Usually found as incidental masses on diagnostic imaging, small kidney tumors are defined as lesions of 4 cm or smaller (American Joint Committee on Cancer stage T1a).1 There has been a 3-fold increase in their detection during the past several decades coincident with increases in imaging utilization.2 In the past, the conventional treatment for most kidney tumors was surgical resection, which mitigated risks of cancer progression but did not result in an overall survival benefit for small tumors.2 More recent evidence suggests that not all of these lesions should be resected because some are benign, and for some patients with small kidney cancers, there is a greater risk for mortality from nononcologic causes than from kidney cancer.

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