A single-centre experience with tumour tract seeding associated with needle manipulation of renal cell carcinomas
E890Cite as: Can Urol Assoc J 2015;9(11-12):E890-93. http://dx.doi.org/10.5489/cuaj.3278 Published online December 14, 2015.
AbstractWith the rise in detection of incidental renal masses on imaging, there has been a commensurate rise in the use of percutaneous biopsies for evaluation of these tumours. Tumour tract seeding had previously been one of the most feared complications of percutaneous biopsy of renal cell carcinoma (RCC). Recently, less emphasis has been placed on this complication, with the assertion that it has only been reported eight times in literature, and thus must be exceedingly rare. However, we report two cases of tumour tract seeding associated with percutaneous biopsy and treatment of RCC over a short time period at a single institution. This report challenges the current extremely low estimates of the frequency of this complication and calls for a more realistic assessment.
IntroductionWith the advent of cross-sectional imaging, the incidence of renal tumours has been on the rise, as these tumours are increasingly being detected at earlier stages in asymptomatic patients.1-6 One study estimates that up to 66% of RCCs are detected incidentally.7 Importantly, not all incidentally detected renal masses on imaging are RCC or malignant in nature. In a recent large series of laparoscopic partial nephrectomies for renal masses, 28-34% of the tumours were identified to be benign at final histology. The indications for performing percutaneous biopsy of renal tumours were historically limited to diagnosis of lymphoma, metastatic disease, infection, or tumours in patients who have an increased surgical risk. 1,5,7,9 With increasing expertise in biopsy performance and the understanding that not all renal masses are malignant and needing invasive measures (such as ablation or nephrectomy), the role of percutaneous biopsy has been on the rise. [1][2][3]5,6 Moreover, recent assessments of safety of renal mass biopsies state that the overall complication rates range from 1.4-4.7%, with major complications reported only in 0.46% of all patients undergoing renal mass biopsies. In particular, the most feared risk of tumour tract seeding has been estimated to be <0.01% with only eight total reported cases in literature to date. [2][3][4][5][6][7]9,10 We report two recent cases of tumour tract seeding associated with percutaneous biopsy and/or treatment (cryoablation) of renal masses at a single institution, suggesting this complication, although rare, may be underreported in literature.
Case reports
Patient AA 63-year-old woman initially presented in early 2009, after an incidental finding of a 3 cm enhancing left upper pole renal mass found during computed tomography (CT) scan obtained for evaluation of exacerbation of sarcoidosis. The patient was asymptomatic and underwent CT-guided biopsy of the left renal mass by interventional radiology. The procedure was performed with a 19-gauge coaxial need...
