New developments in diagnosis and treatment of Small Renal Masses

This thesis addresses a number of current topics in the diagnosis and treatment of Localized Renal Cell Cancer and especially Small Renal Masses. With the increased use of imaging and the accompanying increased incidence of mainly small renal masses, there is enhanced interest in the proper diagnostic work-up for RCC to prevent overtreatment. Renal Tumour Biopsy might help to achieve this goal. Optical coherence tomography could be of additional value in reducing the number of non-diagnostic biopsies. When a Small Renal Mass is diagnosed, different types of treatment are available. Using standard tools could be helpful for this decision-making process. For cT1a tumours nephron-sparing strategies or Active Surveillance are the preferred treatment options. Partial nephrectomy (PN) has been the golden standard. Improvements of surgical technique of PN, for example by using a barbed suture, has been introduced. Currently good alternatives to PN are available. Both cryoablation and Radio Frequency Ablation are already widely used. New technologies, like Irreversible Electroporation, Microwave Ablation and Stereotactic Ablative Body Radiotherapy have emerged and are under investigation. In the future, the focus will be on the search for factors that will enable us to differentiate between kidney tumors that are biologically aggressive requiring treatment and those which are indolent and can be followed with active surveillance. More advanced resources in the diagnostic process and in genetic profiling will give more insight into kidney tumor biology and behavior. Surgical techniques will be refined through 'image-guided' techniques and 'deep-learning' for further surgical navigation.