Accuracy and Clinical Role of Fine Needle Percutaneous Biopsy With Computerized Tomography Guidance of Small (Less Than 4.0 Cm) Renal Masses

Neuzillet, Y.; Lechevallier, É.; André, Marc; Daniel, Laurent; Coulange, C.

doi:10.1097/01.ju.0000120147.51090.2b

Cited by 280 publications

(207 citation statements)

References 12 publications

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“…There were 15 core biopsy studies that used 18G needles. 5,13,15,16,18,20,21,[23][24][25][26][27][28][29][30] Eleven studies included biopsies performed using multiple imaging modalities (primarily CT or ultrasound). Radiation exposure from CT guidance occurred in 44.3%.…”

Section: Resultsmentioning

confidence: 99%

“…2). 5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] One evaluated FNA with cytopathology alone 12 and all other studies evaluated core needle biopsy with surgical pathology. There were 15 core biopsy studies that used 18G needles.…”

Section: Resultsmentioning

confidence: 99%

“…12,24,28,29 Ten included consecutively performed biopsies. 5,12,20,21,[23][24][25][26]28,29 Overall 9 were performed in North America, 5,12,[14][15][16][17]26,27,30 5 in Europe, 13,19,20,28,29 and 3 each in Asia 21,22,24 and Australia. 18,23,25 One study was an update 23 of a previously published series.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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Purpose-Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. (January 1997 to May 2015 for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Materials and Methods-MEDLINE®, Embase® and the Cochrane databases were searchedResults-A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (~80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%).Conclusions-Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility. *Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21207 (telephone: 610-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article. Editor's Note:This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1628 and 1629. HHS Public Access MATERIALS AND METHODSThe methods of this systematic review follow the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews. 9 In an open process representatives of various stakeholder groups developed Key Questions, which are posted on the AHRQ web site for public comments (www.effectivehealthcare.ahrq.gov). The final review protocol was registered on PROSPERO (CRD42015015878, fig. 1). MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1, 1997 through May 1, 2015.The systematic review focused on 3 major topics, of which 1 topic included 2 questions on renal mass sampling for masses suspicious for stage I or II RCC. 1) What is the accuracy (eg sensitivit...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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“…Either a US-or CT-guided approach can be used according to tumour and patient characteristics (LE 2b) [28,30]. At least two quality cores (nonfragmented, >10 mm in length) should be obtained, and necrotic areas should be avoided to maximise diagnostic accuracy (LE 4) [30,32]. Peripheral biopsies are preferable for larger tumours to avoid the central necrosis (LE 2b) [33].…”

Section: Renal Biopsymentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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“…Although few cases have been reported in the literature, 5,12 no cases of seeding have been reported when a coaxial technique is used. 2,[13][14][15][16][17][18][19][20][21] Complication rate of the procedure is low, at around 1%. Bleeding represents the most frequent complication, which usually results in a subcapsular or perinephric haematoma requiring no interventional treatment.…”

Section: Renal Biopsy Techniquementioning

confidence: 99%

The role of renal biopsy in small renal masses

Burruni

Lhermitte

Cerantola

et al. 2016

CUAJ

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Renal biopsy is being increasingly proposed as a diagnostic tool to characterize small renal masses (SRM). Indeed, the wide adoption of imaging in the diagnostic workup of many diseases had led to a substantial increased incidence of SRM (diameter ≤4 cm). While modern ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) techniques have high sensitivity for detecting SRM, none is able to accurately and reliably characterize them in terms of histological features. This is currently of key importance in guiding clinical decision-making in some situations, and in these cases renal biopsy should be considered.In this review, we aim to summarize the technique, diagnostic performance, and predicting factors of nondiagnostic biopsy, as well as the future perspectives.

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Accuracy and Clinical Role of Fine Needle Percutaneous Biopsy With Computerized Tomography Guidance of Small (Less Than 4.0 Cm) Renal Masses

Cited by 280 publications

References 12 publications

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

The role of renal biopsy in small renal masses

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