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| I | Hairline-thin wall; no septa, calcifications, or solid components; water attenuation; no enhancement | Ignore | Ignore |
| II | Few hairline-thin septa with or without perceived (not measurable) enhancement; fine calcification or short segment of slightly thickened calcification in the wall or septa; homogeneously high-attenuating masses (≤3 cm) that are sharply marginated and do not enhance | Ignore | Ignore |
| IIF | Multiple hairline-thin septa with or without perceived (not measurable) enhancement, minimal smooth thickening of wall or septa that may show perceived (not measureable) enhancement, calcification may be thick and nodular but no measurable enhancement present; no enhancing soft tissue components; intrarenal nonenhancing high-attenuation renal masses (>3 cm) | Observe | Observe or ignore |
| III | Thickened irregular or smooth walls or septa, with measurable enhancement | Surgery | Surgery or observe |
| IV | Criteria of category III, but also containing enhancing soft tissue components adjacent to or separate from the wall or septa | Surgery | Surgery or observe |
| General Population | |||
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| Large (>3 cm) | Renal cell carcinoma | Surgery | Angiomyolipoma with minimal fat, oncocytoma, other benign neoplasms may be found at surgery |
| Small (1-3 cm) | Renal cell carcinoma | Surgery | If hyperattenuating, and homogenously enhancing, consider MRI and percutaneous biopsy to diagnose angiomyolipoma with minimal fat |
| Very small (<1 cm) | Renal cell carcinoma, oncocytoma, angiomyolipoma⁎ | Observe until 1 cm | Thin (≤3 mm) sections help confirm enhancement |
| Limited Life Expectancy or High Risk Comorbidities | |||
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| Large (>3 cm) | Renal cell carcinoma | Surgery or observe | Angiomyolipoma with minimal fat, oncocytoma, other benign neoplasms may be found at surgery; biopsy can be used preoperatively to confirm renal cell carcinoma |
| Small (1-3 cm) | Renal cell carcinoma | Surgery or observe | If hyperattenuating, and homogenously enhancing, consider MRI and percutaneous biopsy to diagnose angiomyolipoma with minimal fat |
| Very small (<1 cm) | Renal cell carcinoma, oncocytoma, angiomyolipoma⁎ | Observe until 1.5 cm | Thin (≤3 mm) sections help confirm enhancement |