Pretreatment, ultrasound-guided cutting needle biopsies in childhood renal tumors

Abstract

Background The current International Society of Paediatric Oncology (SIOP)‐10 protocol does not allow pretreatment histological classification of low‐stage renal tumors in children for fear of needle tract recurrences. The aims of this retrospective study were to evaluate the safety, sensitivity, and specificity of ultrasound‐guided cutting needle biopsies (UCNB) performed at our institution in pediatric patients with renal tumors. Procedure Of 28 pediatric patients presenting with a renal tumor between 1988 and 1996, 25 underwent biopsy with the Biopty biopsy instrument (needle diameter 1.2 mm). The preoperative biopsy and nephrectomy slides were reviewed by a SIOP reference pathologist. The patients' hospital records were reviewed and biopsy complications were noted. Results At review of the nephrectomy slides, the diagnoses were: Wilms tumor (16 patients), with anaplasia in one case, rhabdoid tumor (2 patients), neuroblastoma (2 patients), mesoblastic nephroma (2 patients), clear cell sarcoma (1 patient), malignant teratoma (1 patient), and renal cell carcinoma (1 patient). No needle tract recurrence or other major complication was observed. The only complication was local pain at the biopsy site, which occurred in 24% (6/25) of the cases. The sensitivity of UCNB was 76% (19/25); five biopsies did not yield diagnostic material and one was not concordant. All cases of Wilms tumor were correctly diagnosed by UCNB, but only 33% (3/9) of the other tumors. Conclusions In all cases of Wilms tumor a correct diagnosis was made. The overall sensitivity was 76%. UCNB proved to be a safe procedure that was not associated with needle tract recurrence or other serious complications. Med. Pediatr. Oncol. 32:283–288, 1999. © 1999 Wiley‐Liss, Inc.

Indications and results of diagnostic biopsy in pediatric renal tumors: A retrospective analysis of 317 patients with critical review of SIOP guidelines

“…When required, both FNA and CNB techniques provide adequate samples. The cellularity was judged satisfactory in 82% to 85% of our cases, in agreement with the literature (i.e., 76% to 93% for FNA and 80% to 95% for CNB) . However, our data confirm a significantly higher diagnostic accuracy of CNB, as previously reported .…”

“…A low complication rate associated with CNB of renal tumors in children has been reported with an estimated rate of 1.2% in one study . The diagnostic accuracy of CNB in renal tumors was estimated between 93% and 95% in small series . Larger pediatric series assessing the diagnostic accuracy of needle biopsies in solid tumors, but not limited to the kidney, were in agreement with these results …”

Analysis of needle versus open biopsy for the diagnosis of advanced stage pediatric neuroblastoma

“…At our institution, the number of core biopsies obtained from NBX is increasing, paralleling the increasing number of tests that are required to exhaustively characterize NB. The success of NBX in the diagnosis of other tumors is well described in adults and children 4–13, and noted to be independent of operator or number of cores obtained 14.…”

Wilms' tumor and neuroblastoma

“…For example, computed tomography (CT) of the chest at presentation will detect far more lesions than routine chest X-ray imaging (3). However, with such an approach, children with benign renal tumors, such as a mesoblastic nephroma, can receive unnecessary chemotherapy, or children with very rare, but highly malignant cancers, such as rhabdoid tumor or clear cell sarcoma, may be undertreated (4). This is based on the assumption that patients with small-sized pulmonary lesions may be successfully treated with lower dose therapy, because the tumor burden is less than in those patients with metastases evident on plain chest X-ray.…”

“…At present, CT-positive, chest X-ray-negative findings are classified according to the abdominal stage, and not as metastatic disease. Puncture of the tumor capsule and seeding of the tumor have not been systematically studied and reported (4). The true frequency of malignant nodules detected by CT in children with Wilms' tumors is not known.…”