Renal mass size: concordance between pathology and radiology

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Purpose of review

Treatment selection of renal masses is informed largely by size. Furthermore, decisions regarding active surveillance involve closely monitoring growth kinetics. It is, therefore, important to understand the accuracy behind radiographic size as compared with pathologic.

Recent findings

A large number of studies indicate computed tomography (CT) imaging overestimates pathologic size, albeit by a small amount. Smaller masses tend to be overestimated, but larger masses underestimated. Clear cell renal cell carcinoma masses are more likely to be overestimated. CT, ultrasound and MRI have similar concordance with pathologic size.


The differences between radiographic and pathologic size are small. Findings show good efficacy across CT, MRI and ultrasound. This may reduce reliance on CT imaging alone in the future.

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