ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Cancer

J Am Coll Radiol. 2019 Nov;16(11S):S399-S416. doi: 10.1016/j.jacr.2019.05.022.


Renal cell carcinoma (RCC) accounts for most malignant renal tumors and is considered the most lethal of all urologic cancers. For follow-up of patients with treated or untreated RCC and those with neoplasms suspected to represent RCC, radiologic imaging is the most useful component of surveillance, as most relapses and cases of disease progression are identified when patients are asymptomatic. Understanding the strengths and limitations of the various imaging modalities for the detection of disease, recurrence, or progression is important when planning follow-up regimens. This publication addresses the appropriate imaging examinations for asymptomatic patients who have been treated for RCC with radical or partial nephrectomy, or ablative therapies. It also discusses the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC undergoing active surveillance. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Appropriate Use Criteria; Appropriateness Criteria; CT; Diagnostic imaging; MRI; Renal cell carcinoma; Surveillance; Ultrasound; X-ray.

Publication types

  • Review

MeSH terms

  • Biopsy, Needle
  • Carcinoma, Renal Cell / diagnostic imaging*
  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / surgery
  • Contrast Media*
  • Diagnostic Imaging / methods*
  • Evidence-Based Medicine
  • Female
  • Humans
  • Immunohistochemistry
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / pathology
  • Magnetic Resonance Imaging / methods
  • Male
  • Monitoring, Physiologic
  • Nephrectomy
  • Positron Emission Tomography Computed Tomography / methods
  • Practice Guidelines as Topic*
  • Quality Control
  • Radiology / standards
  • Sensitivity and Specificity
  • Societies, Medical / standards
  • Tomography, X-Ray Computed / methods
  • United States
  • Watchful Waiting*


  • Contrast Media