Small renal masses are defined as stage T1a lesions (less than 4cm), but certainly lesions less than 2cm fall into this definition. There is a 126% increase in the detection of renal cell cancers since 1950, due to increased imaging and incidental detection of renal masses. It is suggested that the mean tumor growth rate of a grade 2 renal cancer is 0.28cm/yr, compared to 0.93cm/yr for a grade 3 tumor. The adequacy of a renal biopsy has been demonstrated to by over 96% in numerous studies, with sufficient tissue acquired when an 18 gauge core needle is used. Most often, the core sample is sufficient to provide a histology and tumor grade. These improved biopsy outcomes are the result of improved imaging and the use of a core needle as opposed to needle aspirations, which were historically used. Some argue that a needle biopsy will not change treatment, but 4 studies show that treatment was changed in 30-60% of patients who had a biopsy.

Surveillance is based upon using a biopsy to determine histology and grade. Over 90% of renal masses are

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