Surveillance burden of CT imaging during follow-up for patients after curative treatment for non-metastatic renal cell carcinoma

Follow-up strategies for patients with renal cell carcinoma (RCC) differ across guidelines and predominantly depend on computed tomography (CT) imaging, even though supporting evidence is limited. This study aimed to evaluate the diagnostic yield of follow-up CTs to determine if their frequency can be reduced in the future. This retrospective cohort study included adult patients with non-metastatic RCC treated with curative intent between January 2016 and September 2022. The study evaluated (1) frequency of follow-up CTs retrospectively compared with the 2025 EAU guidelines, (2) abnormal findings at follow-up CTs, and (3) changes in patient management stratified by risk group (low/LR, intermediate/IR, high/HR). In total, 228 patients were included (overall mean follow-up duration of 49.1 (6–99 months)). In the LR and IR group, patients underwent more follow-up CTs than would have been recommended according to the 2025 EAU guidelines. Abnormal CT findings were observed in 66.9%, 68.3%, and 78.9% of cases (LR, IR, HR, respectively). At the scan level, Incidental findings were found between 24.5% and 32.6% of all 1046 performed scans. Proven recurrence or metastases were found in only 2.4, 15.8, and 18.5% of the patients. Notably, among patients who underwent a management change, 90.6%, 52.4%, and 58.8% had no confirmed recurrence or metastases, respectively. This cohort underwent more CT scans than the 2025 EAU guideline recommendations and exceeded the frequency suggested by previous guidelines. The yield of follow-up imaging for detected recurrences was low, particularly among LR patients, suggesting that the current surveillance intensity may warrant re-evaluation. Question What is the diagnostic yield of follow-up CT imaging across risk groups in renal cell carcinoma patients after curative treatment, and does it justify routine surveillance? Findings The diagnostic yield of follow-up CTs was low, with proven recurrences or metastases found in only 2.4%, 14.2%, and 18.5% of low-, intermediate-, and high-risk patients, respectively. Relevance statement The findings suggest that follow-up imaging intensity in RCC patients, particularly in low-risk groups, could potentially be reduced, pending confirmation through prospective studies.