中学副校长年度述职报告推荐.pptVIP

Category IV lesions may contain some or all of the features of category III lesions, but they also contain enhancing soft-tissue components adjacent to or separate from the wall or septa. Cystic renal lesions in this category are renal cancer until proved otherwise. They are almost always malignant. Surgical options include open or laparoscopic nephrectomy and partial nephrectomy; each provides a tissue diagnosis. Open, laparoscopic, and percutaneous ablation may be considered where available, but biopsy would be needed to achieve a tissue diagnosis. Long-term (5- or 10-year) results of ablation are not yet known. Regarding RFA: “Unlike surgery, in which a mass is examined fully at pathologic examination after it is removed, during percutaneous ablation the tumor is treated in situ. Unless biopsy is performed, a tissue diagnosis cannot be obtained. Once a tumor is ablated, the patient needs to be observed as if the lesion was cancerous. Therefore, we recommend that percutaneous ablation be preceded by percutaneous biopsy (in advance of the day of the ablation procedure) to ensure that the mass is malignant and warrants treatment (36,70). Tissue diagnosis is needed for two reasons, to prevent patients from undergoing an unnecessary procedure with its attendant risks (albeit small) and to be sure that the data used ultimately to determine which patients are best treated with ablation do not include benign masses.” /content/249/1/16.full#sec-3 * *Therefore, a radiologist can use small size to lower the probability of a cystic renal mass being malignant but cannot use large size to increase the probability of a cystic renal mass being malignant. Since small cystic lesions (particularly ones smaller than 1–2 cm) are more likely benign, size can be used to conclude that a small cystic lesion that exhibits no other features other than low attenuation is likely benign (except in patients with a genetic predisposition to developing renal cancer). Lesions under 1 cm