Percutaneous renal tumour biopsy

Abstract

The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed.

Bilateral benign renal oncocytomas and the role of renal biopsy: single institution review

“…Familial syndromes can also play a role in the clinical and pathologic presentation of oncocytoma, which is associated with the autosomal dominant Birt-Hogg-Dubé (BHD) syndrome. The most common tumor type found in these patients is a hybrid mixed histology, containing features of both oncocytoma and RCC, [7] often termed “oncocytic neoplasms” by pathologists [13]. …”

“…Diagnostic yield on first biopsy has been shown to be 80.6 to 93% [13, 19, 20] with overall improvement in yield with a subsequent biopsy [13, 19]. Core biopsy sensitivity and specificity are 99.1 and 99.7%, respectively, while FNA is 93.2 and 89.8%, respectively [19].…”

“…Core biopsy sensitivity and specificity are 99.1 and 99.7%, respectively, while FNA is 93.2 and 89.8%, respectively [19]. In addition, complications have not been found to be a major morbidity in RMB, with studies quoting complication rates between 8.5 and 10.4%, most of which were minor and self-limited [13, 20]. Both the high rate of diagnostic accuracy of RMB, as well as the low rate of complications, argues in favor of biopsy and subsequent implementation of an active surveillance protocol.…”

“…Depending on the adequacy of the tissue obtained, pathology can result as either a specific subtype of RCC, RO, or a mix of both, called hybrid oncocytic/chromophobe tumors (HOCT). When pathologists cannot discriminate between chRCC and oncocytoma, the designation of “oncocytic neoplasm” is used [13]. Again, this contributes to a clinical dilemma in how to manage these patients.…”

Renal Splenosis: Renal Mass Biopsy Diagnosis of a Tumor Clinically Mimicking Renal Cell Carcinoma

“…[1][2][3] However, in recent years, these concerns have largely been assuaged, and management algorithms driven by tumor biopsy diagnosis are increasingly used in practice to guide eligibility for less invasive management options, such as surveillance or tumor ablation. 4,5 Therefore, pathologists must be increasingly comfortable in attempting to classify renal tumors, even in relatively limited amounts of biopsy tissue.…”