Accuracy and safety of ultrasound-guided percutaneous needle core biopsy of renal masses: A single center experience in China

Accuracy, safety, and diagnostic prediction of percutaneous renal mass biopsy and subsequent changes in treatment

Introduction

The incidence of renal tumours is increasing annually, and imaging alone cannot meet the diagnostic needs.

Aim

This single-centre study aimed to evaluate the predictors of diagnostic imaging-guided percutaneous renal mass biopsy (PRMB), its accuracy and safety, and subsequent changes to the treatment plan.

Material and methods

We retrospectively collected the clinical data of patients who had undergone PRMB. The diagnosis rate, pathological data, and complications were analysed. Potential predictors of a diagnostic PRMB were evaluated using logistic regression analysis. Changes to the treatment plan due to PRMB results were also analysed.

Results

A total of 158 patients were included in this study. The univariate analysis showed that higher tumour diameter (OR = 1.223, 95% CI: 1.018-1.468, p = 0.031) and number of biopsy cores ≥ 2 (OR = 6.125, 95% CI: 2.006-18.703, p = 0.001) were significantly associated with diagnostic biopsy, and multivariate analysis results showed that higher tumour diameter (OR = 1.215, 95% CI: 1.008-1.463, p = 0.041) was an independent predictor of diagnostic biopsy. A nomogram including tumour diameter and number of biopsy cores was constructed to predict diagnostic biopsy. Compared with postoperative pathology, the concordance between biopsy and postoperative pathology at identifying malignancies, histologic type, and histologic grade were 100% (47/47), 85.1% (40/47), and 54.1% (20/37), respectively. The treatment plans of 15 patients (9.5%) changed based on the PRMB results. Fourteen patients (8.9%) had minor complications (Clavien-Dindo classification < 2).

Conclusions

Our results suggest that tumour diameter was an independent predictor of diagnostic biopsy. Furthermore, PRMB can be accurately and safely performed and may guide clinical decision-making for patients with renal tumours.

Diagnostic accuracy of image-guided core needle biopsy of non-central nervous system tumors in children

BACKGROUND AND AIMS

Core needle biopsies (CNB) are less invasive, cause less morbidity, and have lower costs than open biopsies (OB). However, the number of studies reporting CNB accuracy in pediatric tumors is limited and series are small. The aim of this study is to investigate if CNB diagnosis is concordant with the final diagnosis in pediatric solid non-central nervous system (CNS) tumors.

METHODS

Data from all patients treated in a single center between November 2014 and December 2019 were collected from the national pathology database and from local medical records. Data collection included age, sex, CNB diagnosis, final diagnosis, number of cores obtained, number of cores used for histology, cumulative core length, greatest dimension of the lesion, lesion volume, and complications.

RESULTS

Out of 361 CNB, 95.6% (345/361) provided a diagnosis. A resection or follow-up biopsy was performed in 201 cases. The final diagnosis was concordant with the CNB in 100% (201/201) of cases. The age, number of cores used for histology, and the greatest dimension of the lesion did not significantly differ between diagnostic and nondiagnostic CNB. The cumulative core length of diagnostic CNB was significantly higher than in the nondiagnostic group (24.72 mm vs. 13.37 mm, p-value .022). Complications occurred in 2.1% (7/337) of CNB procedures. Molecular analysis was successful in 228/233 (98%) of cases in which it was performed.

CONCLUSIONS

CNB diagnosis is highly concordant with the final diagnosis and the diagnostic rate is high. The complication rate in CNB is low.

Inflammatory pseudotumor of Castleman disease and IgG4-related disease masquerading as kidney malignancy

Background

With widespread clinical application of imaging techniques, renal space-occupying lesions have been identified at an increasing frequency. Here, we report two rare cases, Castleman disease (CD) and IgG4-related disease (IgG4-RD), presenting primarily with the symptoms and imaging findings of kidney malignancy.

Case presentation

In case 1, an occupying lesion located in the right renal pelvis was detected using magnetic resonance imaging in a 32-year-old female who presented with hematuria and lumbago. First misdiagnosed as carcinoma of the renal pelvis, the patient underwent right radical nephroureterectomy. However, postoperative pathological and immunohistochemistry studies finally confirmed the diagnosis of CD. In case 2, a 45-year-old male presented with the chief complaint of anuria. Nephrostomy and renal biopsy indicated lymphoma, following which, antegrade urography and computed tomography urography were performed, which revealed bilateral hydronephrosis and mass lesions around the renal pelvis. Partial resection of the masses and frozen section examination indicated the diagnosis of CD. However, the results of postoperative histopathology and immunohistochemistry combined with serum IgG4 were consistent with IgG4-RD. Both the patients recovered well after drug treatment without recurrence of the diseases.

Conclusions

Inflammatory pseudotumor of CD and IgG4-RD with kidney involvement are primarily diagnosed by postoperative histopathology and can pose a preoperative diagnostic challenge because these lesions can masquerade as kidney malignancy. Therefore, we recommend core biopsy as a nonnegligible procedure to evaluate renal masses and potentially prevent unnecessary surgical treatment.

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

CONTEXT.—

Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources.

OBJECTIVE.—

To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine.

DATA SOURCES.—

PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies.

CONCLUSIONS.—

Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.