Percutaneous renal tumor biopsies are safe, cost-effective and often conclusive for an acute histological diagnosis. This procedure could be decisive for choosing the optimal treatment, particularly to avoid nephrectomy for benign lesions. Biopsies should not be considered a routine procedure but they could be indicated when there is a lack of radiological evidence in elective patients.
Due to the complex anatomy of the head and neck, a wide range of pedicled or free flaps must be available to ensure optimal reconstruction of the various defects resulting from cancer surgery. The supraclavicular artery island flap is a fasciocutaneous flap harvested from the supraclavicular and deltoid regions. The blood supply of this flap is derived from the supraclavicular artery, a direct cutaneous branch of the transverse cervical artery in 93% of cases or the supraclavicular artery in 7% of cases. The supraclavicular artery is located in a triangle delineated by the posterior border of the sternocleidomastoid muscle medially, the external jugular vein posteriorly, and the median portion of the clavicle anteriorly. This pedicled flap is thin, malleable, and is easily and rapidly harvested with a reliable pedicle and minimal donor site morbidity. It can be used for one-step innervated reconstruction of many types of head and neck defects. It constitutes an alternative to local flaps, while providing equivalent functional results and must be an integral part of the cancer surgeon's therapeutic armamentarium.
To evaluate the utility of imaging-guided fine-needle percutaneous biopsy of renal masses, we conducted a prospective analysis of our imaging-guided procedures from January 1999 to February 2003. We performed 54 percutaneous core biopsies in 46 patients. Fluoro-computed tomography and ultrasound guidance were respectively used in 48 and six cases. One to four specimens were obtained by using an 18-gauge automated coaxial biopsy system. We reviewed the patients medical records, pathology results, and imaging studies. Core biopsy results were compared with surgical pathology (n=27) or clinical follow-up (n=19). All biopsies provided sufficient material for analysis. The mean tumor size was 33 mm. Biopsy findings were positive for malignancy in 31 cases; histologic diagnoses included renal cell carcinoma (n=23), transitional cell carcinoma (n=5), and metastasis (n=3). Biopsy revealed 15 benign diagnoses: oncocytoma (n=6), hemorrhagic renal cyst (n=3), chronic nephritis (n=3), angiomyolipoma (n=2), and mycotic renal abscess (n=1). The average follow-up period for patients with benign diagnoses was 16 months. Biopsy results showed normal renal parenchyma in eight of 54 procedures, all of which had recuperated by subsequent biopsies. No immediate complications occurred after the procedures. Imaging-guided percutaneous core biopsy is a safe and accurate method for the evaluation of renal masses.
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