Ali Bourgi, Gaëlle Margue, Pierre Bigot, Norbert De Brek, Louis Surlemont, Martin Lorette, Nicolas Branger, Thomas Prudhomme, Aurélien Adypagavane, Véra Chatain, Thibaut Waeckel, Alexis Fontenil, Victor Gaillard, Jean-Jacques Patard, Constance Michel, Julien Guillotreau, Olivier Belas, Maxime Vallée, Stéphane De Vergie, Jean-Baptiste Beauval, Clément Sarrazin, Benjamin Delattre, Frédéric Panthier, Lionel Hoquetis, Romain Boissier, Julien Anract, Marie Chicaud, Alexandre Marsaud, Richard Mallet, Quentin-Côme Le Cerlc, Khalil Chalhoub, Idir Ouzaid, Jean-Christophe Bernhard, Franck Bruyère
The diagnostic yield of routine preoperative chest CT in patients with clinical T1 RCC is exceedingly low (<0.5%). These data support the omission of routine chest CT in asymptomatic, low-risk cT1 RCC, potentially sparing over 95% of patients from unnecessary imaging, additional tests and surgical delays. A risk-adapted, symptom-guided strategy may optimize patient care while reducing radiation exposure and healthcare costs.
OBJECTIVE: The aim of this study was to evaluate the diagnostic yield and downstream clinical impact of routine preoperative chest CT in patients undergoing partial nephrectomy (PN) for localized renal cell carcinoma.
METHODS: We conducted a retrospective multicentre study using data from the French Urological Cancer Comprehensive Cohort (UroCCR) registry. Adult patients who underwent PN for localized renal masses between 2010 and 2024 and had preoperative chest CT within 30 days before surgery were included. The primary endpoint was the detection rate of synchronous pulmonary metastases. Secondary endpoints included characteristics of metachronous metastases and diagnostic or scheduling consequences of preoperative imaging.
RESULTS: Among 7351 patients, 6679 underwent surgery and 5016 had a preoperative chest CT. Of these, 4483 (89.4%) had clinical T1 tumours. Synchronous pulmonary metastases were identified in only 17 patients (0.38%), all with larger or higher grade tumours. These patients had significantly higher rates of positive surgical margins (17.6% vs. 6.1%, p = 0.04), but no significant difference in age, sex or comorbidity profile. Among 6075 patients with postoperative follow-up, 191 (3.14%) developed metachronous pulmonary metastases. Of these, 14 (7.3%) had a previously negative preoperative CT, with a median time to progression of 52.6 months. Importantly, 166 (3.7%) patients underwent additional, ultimately non-contributive thoracic investigations, and 2.1% experienced surgical delays due to incidental or equivocal CT findings.
CONCLUSIONS: The diagnostic yield of routine preoperative chest CT in patients with clinical T1 RCC is exceedingly low (<0.5%). These data support the omission of routine chest CT in asymptomatic, low-risk cT1 RCC, potentially sparing over 95% of patients from unnecessary imaging, additional tests and surgical delays. A risk-adapted, symptom-guided strategy may optimize patient care while reducing radiation exposure and healthcare costs.