Role of Percutaneous Needle Biopsy for Renal Masses

Abstract

The role of percutaneous renal mass biopsy has expanded considerably in the past 10 years. The incidence of incidentally detected small (< 4 cm) solid renal masses is on the rise, and despite a commensurate increase in nephron-sparing treatment, the mortality rate from renal cell carcinoma remains the same. Earlier detection and treatment have not had dramatic effects on population outcome, implying that not all small renal masses will grow to be life-limiting. Indeed, many small solid renal masses are benign, and among those that are malignant, not all share the same malignant behavior. Percutaneous biopsy provides a minimally invasive method for discriminating benign from malignant renal masses, and portends the potential for stratifying malignant risk. With recent improvements in image-guided equipment and technique, percutaneous renal mass biopsy can be performed safely and effectively, with a low complication rate (< 5%) and a high diagnostic yield (> 90%).

A single-centre experience with tumour tract seeding associated with needle manipulation of renal cell carcinomas

“…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.…”

“…[1][2][3][4][5][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 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. …”

Urine Aquaporin 1 and Perilipin 2 Differentiate Renal Carcinomas From Other Imaged Renal Masses and Bladder and Prostate Cancer

“…7 There debate on the value of renal mass biopsy ranges having a high diagnostic yield to the optimal use is yet to be determined. 27,28 It should be noted that 2 separate studies of renal mass biopsy results found that about 80% were of diagnostic value while the remaining 20% were non-diagnostic. 18,29 Nevertheless, the sensitivity and specificity of AQP1 and PLIN2 for RCC versus other renal masses supports their analytical and clinical validity, and their potential application in the differential diagnosis and further evaluation of incidentally identified renal masses.…”

Pathology of tumours of the kidney and urinary tract

“…However, renal mass biopsy has been shown to be safe and clinically useful, particularly in the assessment of small renal masses. 1 The diagnostic rate of CT-guided renal mass biopsy has been shown to be in the region of 80e90%, and this technique has a superior diagnostic accuracy to fine needle aspiration cytology. As well as being useful in confirming the diagnosis and classification of malignant tumours, renal core biopsy can detect benign lesions such as renal oncocytoma and angiomyolipoma.…”