The Case against Fine-Needle
Aspiration Cytology for Small Solid
Kidney Tumors

To evaluate the utility of imaging-guided fine-needle percutaneous biopsy of renal masses, we conducted a prospective analysis of our imaging-guided procedures from January 1999 to February 2003. We performed 54 percutaneous core biopsies in 46 patients. Fluoro-computed tomography and ultrasound guidance were respectively used in 48 and six cases. One to four specimens were obtained by using an 18-gauge automated coaxial biopsy system. We reviewed the patients medical records, pathology results, and imaging studies. Core biopsy results were compared with surgical pathology (n=27) or clinical follow-up (n=19). All biopsies provided sufficient material for analysis. The mean tumor size was 33 mm. Biopsy findings were positive for malignancy in 31 cases; histologic diagnoses included renal cell carcinoma (n=23), transitional cell carcinoma (n=5), and metastasis (n=3). Biopsy revealed 15 benign diagnoses: oncocytoma (n=6), hemorrhagic renal cyst (n=3), chronic nephritis (n=3), angiomyolipoma (n=2), and mycotic renal abscess (n=1). The average follow-up period for patients with benign diagnoses was 16 months. Biopsy results showed normal renal parenchyma in eight of 54 procedures, all of which had recuperated by subsequent biopsies. No immediate complications occurred after the procedures. Imaging-guided percutaneous core biopsy is a safe and accurate method for the evaluation of renal masses.

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“…We do not routinely perform aspiration cytology because of its high rate of false-negative results [25].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of imaging-guided fine-needle percutaneous biopsy of renal masses

et al. 2004

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“…Pneumothorax and haemorrhage have been reported [27], and minor bleeding leading to dissection of a tumour from the surrounding perinephric fat has been described [28], which could compromise dissection if a partial nephrectomy was being considered. Multiple passes with the needle through a small tumour can perforate the tumour pseudocapsule, which would again compromise the surgical margins in conservative renal surgery [29].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of fine‐needle aspiration cytology for renal masses

et al. 2000

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Objective To evaluate the accuracy and use of ®ne-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (<5 cm) tumours, are being discovered more frequently. Patients and methods Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42±88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (<5 cm and o5 cm).Patients were followed up to the determination of a ®nal diagnosis on tissue histology, after nephrectomy where possible. Results Thirty-six patients had histologically con®rmed carcinoma at nephrectomy, and nine had presumed carcinoma (four un®t for surgery, ®ve with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insuf®cient sample in eight cases (16%). The sensitivity was 89% for large (o5 cm) solid masses, 64% for small (<5 cm) solid masses and 50% for complex cysts. Conclusion FNA does not contribute to the diagnosis of malignancy in large (>5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (<5 cm) masses and complex cysts, FNA can occasionally con®rm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.

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“…13 The study concluded that FNA of small renal tumors may not be recommended. Goetherys et al 14 in 1996 stated that ''FNA is not recommended if conservative surgery is planned for small solid kidney tumors.'' The exact percent- …”

Section: Discussionmentioning

confidence: 99%