Role of Percutaneous Image-Guided Biopsy in the Evaluation of Renal Masses

Abstract

Objective: The objective of the present study was to evaluate the indications, accuracy, complications and impact of image-guided percutaneous biopsy of renal masses. Materials and Methods: Between 1994 and 1999, percutaneous biopsies under ultrasonography or computerized tomography guidance were performed in 33 patients with renal mass (22 men and 11 women, mean age 57.5 years, range 21–88). We retrospectively analyzed the relationship between clinical and histopathological findings, and discuss the appropriateness of the indications for image-guided percutaneous biopsy in the diagnosis of renal masses. Results: The indications used in our institution were as follows: (1) clinical and radiological findings to suggest a diagnosis other than primary renal cell carcinoma (RCC) (n = 15); (2) suspicious lesions of RCC in multiple cystic renal masses (n = 7); (3) differentiation of transitional cell carcinoma of the renal pelvis from RCC (n = 7); (4) differentiation of angiomyolipoma from RCC (n = 4). Sufficient amounts of tissues were obtained from all patients for pathological diagnosis. Among 33 patients, 21 (63.6%) were diagnosed positive for malignancy, and 15 underwent surgical intervention. The histopathological findings between percutaneous biopsy and surgically resected tissue were identical in 13 cases (86.7%). No patient developed major complications requiring surgical treatment. Conclusion: If performed under appropriate selection of patients, percutaneous image-guided biopsy is a safe, reliable and accurate method of managing suspicious and/or indeterminate renal mass, and may contribute to the selection of appropriate clinical management by avoiding unnecessary procedures.

The Role of Percutaneous Renal Biopsy in the Management of Small Renal Masses

“…Several factors have led to improvement in the diagnostic sufficiency and accuracy of RMB, including enhancement in cross-sectional imaging (usually ultrasound or computed tomography [CT]) and real-time radiographic monitoring, as well as obtaining multiple biopsy specimens. Overall, contemporary RMB literature suggests diagnostic sufficiency rates of 79% to 100% [12][13][14]; diagnostic sufficiency is certainly related to the selection of renal masses for biopsy and the technical expertise of the interventional radiology team performing the biopsy. Assuming biopsy is sufficient for pathologic interpretation, accuracy rates for RMB pathology compared to final nephrectomy pathology are relatively high (86-96%) [12,[14][15][16].…”

Renal Mass Biopsy to Guide Treatment Decisions for Small Incidental Renal Tumors: A Cost-effectiveness Analysis

“…Importantly, the data that we used to inform biopsy performance in our model were derived predominantly from studies that reported use of 18-gauge or larger needles or a combination of core biopsy and fi ne needle aspiration ( 14,(26)(27)(28)(29)(31)(32)(33)(34)(35)60 ), but a few studies used fi ne needle aspiration only ( 11,30 ). Practice patterns in using core biopsy and fi ne needle aspiration for renal tumor sampling differ by institution.…”

“…In eight studies that reported outcomes of patients who opted for imaging surveillance of a known renal mass, in 29% (137 of 475) of these cases, ( 11,14,(26)(27)(28)(29)(30) 0.90 0.5-1.0 Biopsy specifi city ( 14,27,(31)(32)(33)(34)(35)(36) 1.0 0.5-1.0 Probability of nondiagnostic biopsy ( 14 ) * 0.088 (32/362) (0.5-1.5) 3 BCE Probability of biopsy complication ( 14 ) 0.047 (17/362) 0-0.1 Probability of biopsy track seeding with malignant cells ( 12 ) 0.00006 (1/16 381) 0-0.001 NSS mortality rate ( 37 ) 0.016 ( * Indeterminate or insuffi cient specimen. † A yearly probability was reported for simplicity in interpretation, but values used in the model were adjusted to account for cumulative probability of tumor growth at each surveillance point during the 5-year surveillance.…”

“…In a systematic review, Lane et al (14) found no falsepositive results in seven series reported since 2001, with a total of 172 pathologically confi rmed lesions ( 27,(31)(32)(33)(34)(35)(36). False-positive pathologic results that have been reported in the literature (eg, misdiagnosis of an angiomyolipoma [ 63 ] or a multilocular cystic nephroma [ 64 ] as a malignancy) were predominantly reported more than 2 decades ago ( 9 ).…”

Percutaneous ultrasound-guided renal biopsy; A comparison of axial vs. sagittal probe location

“…On the other hand, due to low sensitivity and large cases of non-diagnostic samples, percutaneous cytological biopsy is not agreed upon by everyone [4,5]. Although this method is claimed to have great sensitivity and specificity [6,7], the results of other studies indicate the advantages of surgical methods for sampling to be used in pathology reviews [8]. However, one must keep in mind that imaging guided biopsy has been used only in limited cases to diagnose the renal masses; however, this method can be a good and appropriate choice in studying the small renal masses which are mostly benign.…”