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Isgrò G, Rogers A, Veeratterapillay R, Rix D, Page T, Maestroni U, Bertolotti L, Pagnini F, Martini C, De Filippo M, Ziglioli F. Role of Renal Biopsy in the Management of Renal Cancer: Concordance between Ultrasound/CT-Guided Biopsy Results and Definitive Pathology, Adverse Events, and Complication Rate. J Clin Med 2023; 13:31. [PMID: 38202038 PMCID: PMC10779766 DOI: 10.3390/jcm13010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: In the last decade, the number of detected renal cancer cases has increased, with the highest incidence in Western countries. Although renal biopsy is reported as a safe procedure, it is not adopted in all centres. As it is not possible to accurately distinguish benign tumours using imaging, this may lead to overtreatment. Most of the cancer detected on imaging is treated by surgery, radiofrequency ablation (RFA), or cryotherapy. (2) Methods: This was a single-centre retrospective study of 225 patients studied preoperatively with ultrasound (US)/CT-guided renal biopsy, with the aim of supporting clinical management. Decisions regarding the biopsy were based on either MDT indication or physician preference. US-guided renal biopsy was the first option for all patients; CT-guided biopsy was used when US-guided biopsy was not feasible. The efficacy of renal biopsy in terms of diagnostic performance and the concordance between biopsy results and definitive pathology were investigated. Additionally, adverse events related to the biopsy were recorded and analysed. Data collected throughout the study were analysed using binary logistic regression, Fisher's exact test, and Pearson's chi-square test to investigate possible correlations between post-procedural complications and the size of the lesion. (3) Results: Renal biopsy was not diagnostic in 23/225 (10.2%) patients. A CT-guided approach was necessary in 20/225 patients after failure of US-guided biopsy. The complication rate of renal biopsy was 4.8% overall-all Clavien grade I and without any serious sequelae. Interestingly, complications occurred in patients with very different sizes of renal cell carcinoma. No correlation between complications and anticoagulant/antiplatelet drugs was found. No seeding was reported among the patients who underwent partial/radical nephrectomy. (4) Conclusions: Renal biopsy was shown to be safe and effective, with a high concordance between biopsy results and definitive pathology and a low rate of complications. The use of a CT-guided approach whenever the US-guided approach failed improved the diagnostic performance of renal biopsy.
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Affiliation(s)
- Gianmarco Isgrò
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Alistair Rogers
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - David Rix
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Toby Page
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Pagnini
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Chiara Martini
- Department of Medicine and Surgery, University-Hospital of Parma, 43100 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
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Trivedi J, Talwar A, Nada A, Li S, Lee A, Sutherland TR. Targeted Renal Biopsy: Predictors on Imaging. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1757785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Objectives The renal nephrometry score uses imaging characteristics such as lesion diameter, location, and proximity to hilar vessels to categorize renal masses by complexity for preoperative planning. These characteristics may also be used to determine the best approach to targeted renal biopsy. This study was conducted to investigate the impact of renal lesion characteristics as measured by the renal nephrometry score on the choice of modality used for performing a targeted renal lesion biopsy and increasing the chance of yielding a diagnostic biopsy.
Materials and Methods All targeted computed tomography (CT)/ultrasound-guided renal biopsies performed by our radiology department from January 2017 to February 2020 were reviewed. Radiological characteristics and pathological outcomes were recorded with data on lesion size/ side, location in craniocaudal/anterior–posterior planes, endophytic/exophytic/mixed nature, and skin-lesion distance.
Statistical Analysis Chi-squared tests, multivariate analysis, and t-tests were used in this study.
Results Of the 145 consecutive patients included in the study, 86.2% (125/145) biopsies were diagnostic. About 54.5% (79/145) biopsies were ultrasound-guided, while 45.5% (66/145) were CT-guided. About 62.1% (90/145) biopsies revealed renal cell carcinoma. The highest rate of diagnostic biopsy was in the exophytic, laterally positioned mass either entirely below lower polar or above upper polar line. Ultrasound was preferred for lesions under 4cm and 4 to 7cm (p = 0.06). CT was used for anterior lesions and ultrasound for posterior and lateral lesions (p < 0.001). Of the 20 nondiagnostic biopsies, 7/20 had a repeat biopsy, 7/20 underwent surveillance, 5/20 underwent partial or total nephrectomy, and 1/20 underwent a pathological lymph node biopsy.
Conclusions Our study highlights some factors radiologists should consider when predicting whether CT or ultrasound guidance is more appropriate and the probability of achieving a diagnostic biopsy based on lesion characteristics. At our institution, both modalities achieved high accuracy, although we favored ultrasound in lateral, posterior, and small lesions. These factors should be weighed against local experience and preference.
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Affiliation(s)
- Janki Trivedi
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Arpit Talwar
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ahmed Nada
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Simon Li
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Adele Lee
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tom R. Sutherland
- Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Kurban LAS, Vosough A, Jacob P, Prasad D, Lam T, Scott N, Somani BK. Pathological nature of renal tumors - does size matter? Urol Ann 2017; 9:330-334. [PMID: 29118533 PMCID: PMC5656956 DOI: 10.4103/ua.ua_17_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We examined the relationship between the size and nature of renal masses in term of malignant potential, histological grading, pathological staging and presence of necrosis and sarcomatoid changes. MATERIALS AND METHODS Retrospectively, we reviewed 323 consecutive nephrectomies between 2000 and 2010. Final pathology was correlated with tumour size. The renal tumours were stratified into three groups according to the largest diameter, defined as 4 cm or smaller, greater than 4 cm to 7 cm, and greater than 7 cm. We recorded the proportion of benign tumours, tumour grade and stage, presence of necrosis and sarcomatoid change. RESULTS Small renal masses ≤4 cm (SRMs) were more likely to be localised to the kidney (90%) and of lower histological grade (75%). The proportion of benign tumours in SRMs (15%) was higher than other two groups with the majority of benign tumours being oncocytomas. There was a statistically significant trend with greater necrosis and sarcomatoid change for the large size group. CONCLUSIONS SRMs are likely to be low grade and organ confined with little or no adverse pathological features. There is increased likelihood of benignity in SRTs with the majority of benign tumours being oncocytomas.
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Affiliation(s)
- Lutfi Ali S. Kurban
- Department of Radiology, Clinical Imaging Insitute, Al Ain Hospital, Al Ain, Abu Dhabi, UAE
| | | | - Preman Jacob
- Department of Interventional Radiology, St. Paul's Hospital, Saskatoon, SK, Canada
| | - Deepak Prasad
- Department of Radiology, PRP Diagnsotic Imaging Limited Bathurst, 2795 New South Wales, Australia
| | - Thomas Lam
- Department of Academic Urology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Neil Scott
- Department of Medical Statistics, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
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Dhyani M, Grajo JR, Rodriguez D, Chen Z, Feldman A, Tambouret R, Gervais DA, Arellano RS, Hahn PF, Samir AE. Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms. Abdom Radiol (NY) 2017; 42:1734-1743. [PMID: 28197683 DOI: 10.1007/s00261-017-1061-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms. MATERIALS AND METHODS Two independent cohorts-an initial (biopsy) dataset and a validation (surgical) dataset-with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated. RESULTS Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p < 0.001), early excretory phase (p < 0.001), and excretory phase (p = 0.029). The area under the ROC curve for the nephrographic phase was 1.00 (95% CI: 1.00-1.00) for the biopsy dataset and showed the narrowest confidence interval. At a threshold value of 25.5 HU, sensitivity was 100 (82.2%-100%) and specificity was 81.5 (61.9%-93.7%). When tested on the validation dataset on measurements made by an independent reader, the AUROC was 0.93 (95% CI: 0.84-1.00) with a sensitivity of 100 (80.0%-100%) and a specificity of 87.5 (60.4%-97.8%). CONCLUSIONS Nephrographic phase ALAD has potential to differentiate benign and malignant oncocytic renal neoplasms on contrast-enhanced CT if histologic evaluation on biopsy is indeterminate.
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Leão RRN, Richard PO, Jewett MAS. Indications for biopsy and the current status of focal therapy for renal tumours. Transl Androl Urol 2016; 4:283-93. [PMID: 26816831 PMCID: PMC4708239 DOI: 10.3978/j.issn.2223-4683.2015.06.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The increased detection of small renal masses (SRMs) has focused attention on their uncertain natural history. The development of treatment alternatives and the discovery of biologically targeted drugs have also raised interest. Renal mass biopsies (RMBs) have a crucial role as they provide the pathological, molecular and genetic information needed to classify these lesions and guide clinical management. The improved accuracy has improved our knowledge of the behaviour of different tumour histologies and opened the potential for risk-adapted individualized treatment approaches. To date, studies have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical setting. Although partial nephrectomy (PN) is still considered the standard treatment for SRM, percutaneous ablation is increasingly being performed and if long-term efficacy is sustained, it may have a wider application for SRMs after biopsy characterization.
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Affiliation(s)
- Ricardo R N Leão
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Patrick O Richard
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Guerrero-Ramos F, Villacampa-Aubá F, Jiménez-Alcaide E, García-González L, Ospina-Galeano I, de la Rosa-Kehrmann F, Rodríguez-Antolín A, Passas-Martínez J, Díaz-González R. Renal biopsy with 16G needle: a safety study. Actas Urol Esp 2014; 38:584-8. [PMID: 24533921 DOI: 10.1016/j.acuro.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/01/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVE The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. MATERIAL AND METHODS A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. RESULTS Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P=.09) previous anticoagulation (P=.099) or previous antiaggregation (P=.603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. CONCLUSIONS Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance.
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Scanga LR, Maygarden SJ. Utility of fine-needle aspiration and core biopsy with touch preparation in the diagnosis of renal lesions. Cancer Cytopathol 2013; 122:182-90. [DOI: 10.1002/cncy.21371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/03/2013] [Accepted: 10/29/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Lori R. Scanga
- Department of Pathology and Laboratory Medicine; The University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Susan J. Maygarden
- Department of Pathology and Laboratory Medicine; The University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Salem S, Ponsky LE, Abouassaly R, Cherullo EE, Isariyawongse JP, MacLennan GT, Nakamoto D, Haaga JR. Image-guided biopsy of small renal masses in the era of ablative therapies. Int J Urol 2012. [DOI: 10.1111/iju.12010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Sepehr Salem
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Lee E Ponsky
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Robert Abouassaly
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Edward E Cherullo
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Justin P Isariyawongse
- Urologic Oncology and Minimally Invasive Therapies Center; Urology Institute; University Hospitals Case Medical Center; Cleveland; Ohio; USA
| | - Gregory T MacLennan
- Department of Pathology; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
| | - Dean Nakamoto
- Department of Radiology; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
| | - John R Haaga
- Department of Radiology; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland; Ohio; USA
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Gontero P, Joniau S, Oderda M, Ruutu M, Van Poppel H, Laguna MP, de la Rosette J, Kirkali Z. Active surveillance for small renal tumors: Have clinical concerns been addressed so far? Int J Urol 2012; 20:356-61. [DOI: 10.1111/j.1442-2042.2012.03227.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/05/2012] [Indexed: 01/23/2023]
Affiliation(s)
- Paolo Gontero
- Department of Urology; A.O.U. San Giovanni Battista; University of Turin; Turin; Italy
| | - Steven Joniau
- Department of Urology; University Hospitals Leuven; Leuven; Belgium
| | - Marco Oderda
- Department of Urology; A.O.U. San Giovanni Battista; University of Turin; Turin; Italy
| | - Mirja Ruutu
- Department of Urology; Helsinki University Central Hospital; Helsinki; Finland
| | - Hein Van Poppel
- Department of Urology; University Hospitals Leuven; Leuven; Belgium
| | - M Pilar Laguna
- Department of Urology; AMC University Hospital; Amsterdam; the Netherlands
| | - Jean de la Rosette
- Department of Urology; AMC University Hospital; Amsterdam; the Netherlands
| | - Ziya Kirkali
- Department of Urology; Dokuz Eylül University School of Medicine; Izmir; Turkey
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The emerging role of percutaneous biopsy in diagnosis and management of small renal masses. Curr Opin Urol 2012; 22:360-4. [DOI: 10.1097/mou.0b013e3283542bc5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Volpe A, Finelli A, Gill IS, Jewett MA, Martignoni G, Polascik TJ, Remzi M, Uzzo RG. Rationale for Percutaneous Biopsy and Histologic Characterisation of Renal Tumours. Eur Urol 2012; 62:491-504. [DOI: 10.1016/j.eururo.2012.05.009] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/03/2012] [Indexed: 12/18/2022]
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Menogue SR, O'Brien BA, Brown AL, Cohen RJ. Percutaneous core biopsy of small renal mass lesions: a diagnostic tool to better stratify patients for surgical intervention. BJU Int 2012; 111:E146-51. [DOI: 10.1111/j.1464-410x.2012.11384.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Pallwein-Prettner L, Flöry D, Rotter CR, Pogner K, Syré G, Fellner C, Frauscher F, Aigner F, Krause FS, Fellner F. Assessment and characterisation of common renal masses with CT and MRI. Insights Imaging 2011; 2:543-556. [PMID: 22347975 PMCID: PMC3259318 DOI: 10.1007/s13244-011-0116-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 05/12/2011] [Accepted: 06/28/2011] [Indexed: 01/19/2023] Open
Abstract
Objective Owing to the widespread use of abdominal imaging studies the detection rate of solid renal masses has increased, and an accurate characterisation of imaging features of renal masses has become more essential for case management. Method and results MR imaging (MRI) and computed tomography (CT) are frequently used modalities for detection and differentiation of renal masses. This article gives a review of imaging characteristics of benign and malignant renal masses, discussing their appearance in CT and MR imaging. Advanced MR techniques like diffusion-weighted imaging and apparent diffusion coefficient (ADC) mapping, which have shown promising results in the differentiation between benign and malignant renal lesions, will be introduced. Conclusion MRI and CT are useful in the characterisation and estimation of the prognosis for renal masses.
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Affiliation(s)
- Leo Pallwein-Prettner
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Daniel Flöry
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | | | - Kurt Pogner
- Department of Urology, General Hospital Linz, Linz, Austria
| | - Gerhard Syré
- Department of Pathology, General Hospital Linz, Linz, Austria
| | - Claudia Fellner
- Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | | | - Friedrich Aigner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Franz Fellner
- Department of Radiology, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
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Pusiol T, Zorzi MG, Morichetti D, Piscioli I, Scialpi M. Uselessness of percutaneous core needle renal biopsy in the management of small renal masses. Urol Int 2011; 87:125-6. [PMID: 21701144 DOI: 10.1159/000328195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 04/01/2011] [Indexed: 11/19/2022]
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Abstract
Clear cell renal cell carcinoma (RCC) represents the most common histological subtype of malignant kidney tumors. Based on symptoms alone, clear cell RCC is indistinguishable from other histological classes of RCC unless the tumor is present in the context of an RCC syndrome. Histopathological examination is, therefore, important to accurately identify clear cell RCC. Clear cell RCCs have characteristic morphological criteria; these tumors can be easily identified upon typical presentation, but diagnosis can be challenging when tumor cell pattern is unusual or when availability of tissue samples is limited. In this Review, the clinical, radiological and pathological characteristics of clear cell RCCs are described, as well as the potential tumors that can be confused with clear cell RCC and need to be considered in the differential diagnoses. Finally, the importance of an accurate diagnosis is highlighted in the context of the increasing use of preoperative tissue sampling and the prevalence of clear cell tumors associated with hereditary syndromes, which could have different therapeutic and prognostic implications for patients and their families.
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Affiliation(s)
- Vladimir A Valera
- Translational Surgical Pathology section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, MSC Room 2B44, Bethesda, MD 20892, USA
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Abstract
PURPOSE Historically, the biopsy of renal masses was not advocated, and to date there remains some controversy on the role of biopsy for renal masses in making treatment decisions. With the widespread use of imaging methods, the incidental diagnosis of renal masses has increased, necessitating renal biopsies to better plan the management of these tumours. Here I review previous reports to define the role of biopsy in incidental renal tumours. METHODS Data were obtained from English-language studies listed in PubMed on the use of renal biopsy for evaluating incidental solid small renal tumours. RESULTS The biopsy of small renal tumours is increasingly accepted due to: the increase in the incidence of small renal tumours; the finding that a significant number of these tumours are benign; the availability of new management options, such as ablative therapy and surveillance strategies; that imaging alone is unable to predict the biological behaviour of these tumours; and advances in the pathological evaluation of the biopsies. The biopsy procedure has an acceptable complication rate but is not free of limitations. The current recommendations for the use of renal biopsy in small renal tumours are: to help in differentiating benign from malignant renal tumours; before or during ablative therapies and during the follow-up after ablative therapies, for defining treatment success or failure; and to exclude nonrenal cell primary tumours (metastasis and lymphoma) or benign conditions (abscess), which may not require surgery. CONCLUSIONS The biopsy of small renal tumours is a safe and accurate procedure, and can help in the planning of definitive patient management.
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