Cystic Renal Lesions: A Systematic Review of Diagnosis and Treatment

Abstract

BACKGROUND: Renal cysts are the most frequently occurring incidental renal lesions. They are asymptomatic, which explains why they tend to be diagnosed incidentally as a result of imaging tests. In cases where malignancy is suspected, there are various therapeutic alternatives. OBJECTIVE: The objective of this study is to review the diagnostic and therapeutic alternatives for cystic renal lesions. METHOD: A systematic search was conducted in Pubmed, Science Direct, Scopus, and Google Scholar databases between May and October 2022. The review of articles was conducted following the methodological recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 Statement. As a result, 25 articles were selected. RESULTS: Thirteen studies focused on diagnostic management. In five of the cases ultrasound was used, multiparametric magnetic resonance imaging (mpMRI) was considered in six articles, and computerized tomography (CT) was studied in three. Eleven papers were retrospective series, one of the studies was prospective, and one was a simulated cost-effectiveness model. Among the 12 articles on treatment, five focused on surgery and one on the results of active surveillance, while three compared active surveillance with other treatments. Four articles assessed the percutaneous approach and radiofrequency ablation. All articles were retrospective cohorts. CONCLUSIONS: CT is the most standard of the tests. In doubtful cases, mpMRI and ultrasound can serve as complementary tests. Partial nephrectomy is currently the gold standard treatment and the results are similar for both open and laparoscopic approaches. Percutaneous radiofrequency treatments produce reasonable survival rates free of local recurrence and metastasis and are recommended in patients with high surgical risk.