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Abdominal Radiology

, Volume 43, Issue 7, pp 1813–1819 | Cite as

Percutaneous image-guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation, and clinical significance

  • Nisha Alle
  • Nelly Tan
  • Julie Huss
  • Jiatoi Huang
  • Allan Pantuck
  • Steven S. Raman
Article

Abstract

Purpose

To determine the efficacy, safety and clinical utility of CT and US-guided percutaneous renal mass biopsy.

Materials and methods

A retrospective IRB-approved, HIPAA-compliant study of a cohort of 183 consecutive patients who underwent percutaneous, CT or US—guided renal mass biopsy (RMB) from March 2002 through December 2012 was performed. RMB was performed in 183 consecutive patients for suspected solid renal mass of whom 14/183 (7.7%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Ten patients had multiple biopsies for new growing masses. Using US, CT or CT/US fusion-guidance, a 17G or 19G cannula needle was placed at the margin of the mass and an 18G or 20G core biopsy gun was used to obtain several tissue cores. Renal parenchymal biopsies for medical renal diseases were excluded. Imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, immunohistochemical (IHC) studies, and subsequent final pathological diagnosis on nephrectomy were evaluated.

Results

Of the 169 patients with 184 RMB, 121/169 (71.6%) were male with a mean age of 67.5 years. Of 184 RMB, 126 were malignant [126/184 (68.5%)], 37 [37/184 (20.1%)], were benign, and 21 (21/184 (11.4%) were nondiagnostic. IHC was performed in 131 biopsies (71.1%) and was diagnostic in 88.5% of those cases. Twenty-eight patients underwent subsequent partial nephrectomy; in 27/27 (100%) cases, RMB was concordant with nephrectomy for malignancy and in 21/27 (77.8%) RMB was concordant for subtype of RCC. Overall, the RMB sensitivity for detection of malignancy, specificity, and positive predictive value were 100%. The negative predictive value of benign RMB diagnosis was also 100%. There was a total of 14 (7.6%) complications, 13 minor (7.1%) and 1 major (0.5%). Of the minor complications, ten (5.5%) were postprocedural minor hematomas that resolved conservatively; one (0.5%) postprocedural vasovagal reaction; one (0.5%) episode of hematuria; and one (0.5%) episode of nausea and abdominal discomfort. No cases of renal pseudoaneurysm or tumor seeding attributed to biopsy were identified.

Conclusion

Percutaneous image-guided RMB is safe and highly diagnostic when combined with IHC and supports a greater role of RMB and imaging in evaluating renal masses when rendering appropriate treatments.

Keywords

Renal mass biopsy Renal cell carcinoma Intervention 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Nisha Alle
    • 1
    • 5
  • Nelly Tan
    • 1
  • Julie Huss
    • 3
  • Jiatoi Huang
    • 4
  • Allan Pantuck
    • 2
  • Steven S. Raman
    • 1
    • 2
  1. 1.The Department of RadiologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.The Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.The Department of PathologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  4. 4.The Department of PathologyDuke University School of MedicineDurhamUSA
  5. 5.Department of RadiologyRonald Reagan-UCLA Medical CenterLos AngelesUSA

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