Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.

小肾肿块（SRM）是一组具有不同转移潜力的异质性肿瘤。腹部影像学使用的增加和质量的提高使得对无症状和器官受限的偶发性 SRM 的早期诊断越来越多。尽管影像学有所进步并且肾肿块活检的使用越来越多，但治疗前的恶性肿瘤诊断仍然具有挑战性。 SRM 的管理已不再是根治性肾切除术，而是主动监测和保留肾单位的手术成为主要的治疗方式。随着前瞻性数据登记研究阐明了影响该患者队列短期和长期结果的因素，SRM 的最佳治疗策略不断发展。生物标志物、成像模式和机器学习方面快速发展的研究证据表明，有望提高对这一患者群体的生物学和管理的理解。