85 © Springer International Publishing AG, part of Springer Nature 2019 M. A. Gorin, M. E. Allaf (eds.), Diagnosis and Surgical Management of Renal Tumors, https://doi.org/10.1007/978-3-319-92309-3_6 Chapter 6 Imaging-Based Scoring Systems for the Risk Stratifcation of Renal Tumors Andrew G. McIntosh, Shreyas Joshi, Robert G. Uzzo, and Alexander Kutikov Introduction Patients presenting with a renal mass pose a unique and often complex set of chal- lenges to the clinician. Individualizing an optimal treatment strategy requires the evaluation of a broad array of considerations and competing risks. Factors that can help match disease risk to treatment intensity can be patient-related and/or tumor- related. Patient-related risks such as age and comorbidity are well-established [1, 2], while tumor-related risks are the subject of ongoing clinical [3–5] and basic science research [6, 7]. To better describe and classify tumors, imaging-based scoring sys- tems have been developed that can standardize reporting and guide management [8–14]. Higher utilization of cross-sectional imaging has led to an increase in identifca- tion of early stage renal masses [5]. In parallel, management strategies for renal masses have expanded from radical nephrectomy in all-comers to individualized application of nephron-sparing surgery, tumor ablation, and active surveillance [3, 15, 16]. To better objectify patient selection for these various management approaches, effective communication of tumor anatomic characteristics has become increasingly necessary. To this end, the frst standardized system for objective reporting of renal mass anatomic complexity, the R.E.N.A.L. nephrometry score, was introduced in 2009 by Kutikov and Uzzo [8]. This scoring system allows for renal tumor size, location, and depth to be quantifed in a standardized fashion. Subsequently, a variety of other scoring systems were developed to similarly A. G. McIntosh (*) Department of Urology, Temple University Hospital, Temple Health, Philadelphia, PA, USA S. Joshi · R. G. Uzzo · A. Kutikov Department of Surgical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA e-mail: shreyas.joshi@fccc.edu; robert.uzzo@fccc.edu; alexander.kutikov@fccc.edu