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Vian J, Shabaka A, Lallena S, Gatius S, Lopez de la Manzanara V, Barrera-Ortega J, Méndez-Fernández RJ. Efficacy and Safety of CT-Guided Kidney Biopsy for the Diagnosis of Glomerular Diseases in Complicated Patients. Nephron Clin Pract 2023; 148:16-21. [PMID: 37429269 DOI: 10.1159/000531378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Kidney biopsy is the cornerstone for the diagnosis of glomerular diseases and to guide treatment. Percutaneous ultrasound-guided kidney biopsy is currently the gold standard to obtain cortical specimens. However, in cases where ultrasound-guided kidney biopsy is not deemed safe (obese patients, deep kidneys, or kidneys with a complicated anatomy), CT-guided kidney biopsy could be a convenient alternative to obtain renal tissue samples. The aim of this study was to describe the diagnostic yield and complications of CT-guided kidney biopsies in patients with glomerular diseases that were previously discarded for ultrasound-guided kidney biopsy. MATERIAL AND METHODS We performed a retrospective, single-center, observational study including patients who underwent CT-guided native kidney biopsies in our center after being contraindicated for ultrasound-guided biopsy. Patients' records were reviewed retrieving baseline characteristics and pre-biopsy clinical, laboratory parameters and concomitant medication. The biopsy needle gauge, site of puncture, and number of needle passes were recorded. The diagnostic yield was evaluated by the number of glomeruli obtained, the rate of specimens that were adequate to reach diagnosis, and the number of biopsies that had to be repeated. Complications were defined as minor (hypotension, hematoma) and major (arteriovenous fistulae, major bleeding requiring embolization, or nephrectomy). The diagnostic yield and complications were compared to ultrasound-guided native kidney biopsies performed during the same period. RESULTS 56 CT-guided native kidney biopsies were performed during the study period. The number of glomeruli obtained per patient was 11.5 ± 6.3, which was inferior to that obtained from ultrasound-guided biopsies (14.08 ± 8.47, p < 0.05). However, the rate of specimens that were adequate to reach a diagnosis was similar (92.9% vs. 90.8%, p = 0.437). The number of needle passes was higher in CT-guided kidney biopsies (2.0 ± 0.7 vs. 1.7 ± 0.5, p < 0.05), as well as the incidence of post-biopsy perirenal asymptomatic hematomas (66.1% vs. 24.5%, p < 0.01). There were no significant differences in other post-biopsy minor complications (1.8% vs. 2.5%, p = 0.621). There were no major complications after CT-guided kidney biopsies. CONCLUSIONS CT-guided percutaneous kidney biopsy is a valid alternative for the diagnosis of glomerular diseases in patients with special characteristics such as obesity or deep kidneys that contraindicate ultrasound-guided biopsy. In this population, CT-guided kidney biopsies are safe and provide a high diagnostic yield, reaching a diagnosis in >90% of patients that had been previously discarded for ultrasound-guided biopsy.
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Affiliation(s)
- Javier Vian
- Nephrology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Amir Shabaka
- Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Silvia Lallena
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Serena Gatius
- Nephrology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Jiang P, Arada RB, Okhunov Z, Afyouni AS, Peta A, Brevik A, Xie L, Ayad M, Xu P, Morgan K, Tapiero S, Patel RM, Nelson KJ, Lee JG, Clayman R, Landman J. Multidisciplinary Approach and Outcomes of Pretreatment Small (cT1a) Renal Mass Biopsy: Single-Center Experience. J Endourol 2022; 36:703-711. [PMID: 35018788 DOI: 10.1089/end.2021.0664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated our experience of a multidisciplinary approach to renal mass biopsy (RMB) for small renal masses (SRM) employing in-office ultrasound (US) guided biopsy by urology (24%), computed tomography (CT) or US biopsy by interventional radiology (IR) (79%), and endoscopic ultrasound-guided biopsy by gastroenterology (GI) (4%). METHODS A single-institution retrospective review of patients who underwent RMB for SRM from May 2013 to August 2019 was conducted. Data regarding patient demographics, tumor characteristics, biopsy technique, histopathology, and management were collected. Diagnostic rates, concordance with final pathology, complications, and outcomes were analyzed. RESULTS Of the 192 biopsies reviewed, 63% biopsies were malignant, 20% were benign, and 17% were non-diagnostic. Based on biopsy results, 71 patients (37%) elected active surveillance. Thirty-eight (20%) patients underwent cryoablation, 56 (29%) underwent partial nephrectomy (PN), 14 (7%) underwent radical nephrectomy (RN) and the remaining patients were treated elsewhere. The rate of surgery for benign pathology after pretreatment RMB was 3%. The concordance rate between biopsy and final pathology was 99% for malignancy, 96% for specific pathology subtype, and 85% for RCC grade. Median time from diagnosis to definitive treatment was 97 days (urology: 76, IR: 110 and GI: 54, p=0.002). Three (1.6%) Clavien I complications were reported. CONCLUSION Our multidisciplinary approach to renal mass biopsy for clinical stage T1a demonstrated favorable safety and diagnostic rates, which effectively directed management strategies and minimized surgery for benign disease. Urologist performed office-biopsies significantly shortened the time from diagnosis to definitive treatment. Our experience with GI EUS biopsy has demonstrated feasibility and safety for tumors that were otherwise not accessible percutaneously.
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Affiliation(s)
- Pengbo Jiang
- University of California Irvine, 8788, Urology, 333 The City Blvd West, Suite 2100, Irvine, California, United States, 92868;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Zhamshid Okhunov
- University of California, Irvine, Urology, 333 City Boulevard, Suite 2100, 333 City Boulevard, Suite 2100, Orange, California, United States, 92868;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, 29 Prairie Grass, Irvine, California, United States, 92603;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Irvine, California, United States, 92868;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,UC Irvine Health, California, United States;
| | - Lillian Xie
- University of California Irvine, 8788, Urology, 333 City Blvd W, Suite 2100, Orange, California, United States, 92868;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, 101 The City Drive S, Orange, California, United States, 92868;
| | - Perry Xu
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Kalon Morgan
- University of California Irvine, 8788, Urology, Irvine, California, United States;
| | - Shlomi Tapiero
- University of California Irvine, 8788, Urology, 333 City Blvd W, Suite 2100, Irvine, California, United States, 92697;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Kari J Nelson
- University of California Irvine, 8788, Radiology, Irvine, California, United States;
| | - John G Lee
- University of California Irvine, 8788, Gastroenterology and Hepatology, Irvine, California, United States;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, Urology, 333 City Blvd West, Orange, California, United States, 92868;
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Dutta R, Okhunov Z, Vernez SL, Kaler K, Gulati AT, Youssef RF, Nelson K, Lotan Y, Landman J. Cost Comparisons Between Different Techniques of Percutaneous Renal Biopsy for Small Renal Masses. J Endourol 2016; 30 Suppl 1:S28-33. [PMID: 26915901 DOI: 10.1089/end.2016.0015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs). METHODS We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology. RESULTS A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were $3449, $3280, and $1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologist's and radiologist's professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were $4598, $4470, and $2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001). CONCLUSION For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.
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Affiliation(s)
- Rahul Dutta
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Simone L Vernez
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kamaljot Kaler
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Anjalie T Gulati
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Ramy F Youssef
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kari Nelson
- 2 Department of Radiology, University of California , Irvine, Orange, California
| | - Yair Lotan
- 3 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jaime Landman
- 1 Department of Urology, University of California , Irvine, Orange, California
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