European Radiology

, Volume 12, Issue 10, pp 2518–2524

CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management

  • Erich K. Lang
  • Richard J. Macchia
  • Brian Gayle
  • Frank Richter
  • Richard A. Watson
  • Raju Thomas
  • Leann Myers
Urogenital

DOI: 10.1007/s00330-001-1292-z

Cite this article as:
Lang, E.K., Macchia, R.J., Gayle, B. et al. Eur Radiol (2002) 12: 2518. doi:10.1007/s00330-001-1292-z

Abstract.

The purpose of this study was to determine ability of cyst aspiration and core biopsy to differentiate malignancies, and benign lesions needing intervention from benign complex cysts in the group of Bosniak 2F and 3 renal cysts. One hundred ninety-nine indeterminate complex renal cysts were biopsied under CT or US guidance using a coaxial system (19-G sheath, 20- or 21-G Chiba or Franseen or 18-G spring biopsy needle). Cytology, amylase, lipase, LDH, fat, protein, urea nitrogen, creatine, and culture and sensitivity were assessed in all patients, histopathology in 116, and flow cytometry in 32. In 179 patients (87.9%) a definitive diagnosis was made; in 20 the specimen was inadequate. Twenty of 28 malignancies were correctly diagnosed (sensitivity 0.71); 27 of 31 benign lesions needing intervention (sensitivity 0.87) and 128 of 140 benign complex cysts (sensitivity 0.91). All inconclusive biopsies were explored revealing six malignancies. There were four CT biopsy misdiagnoses: two renal cell carcinomas; one angiomyolipoma; and one abscess. Guided cyst puncture aspiration and core biopsy significantly altered management of Bosniak 3 and 2F renal cysts obviating surgery or invasive procedures in 70% of the patients with an affirmed diagnosis of benign complex cyst and rendering timely surgical and other interventions in the remaining patients. Long-term follow-up (mean 5.6 years) revealed no further misdiagnosis.

Kidney Cystic neoplasms Cyst biopsy Computed tomography 

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Erich K. Lang
    • 1
  • Richard J. Macchia
    • 2
  • Brian Gayle
    • 2
  • Frank Richter
    • 3
  • Richard A. Watson
    • 3
  • Raju Thomas
    • 1
  • Leann Myers
    • 4
  1. 1.Departments of Radiology, SL-54, Tulane Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112USA
  2. 2.Departments of Radiology and Urology, SUNY, Downstate Medical School, 445 Lennox Road, Box 79, Brooklyn, NY 11203USA
  3. 3.Department of Surgery, Division of Urology, University Hospital UMDNJ 185 So. Orange Avenue, G-536 Medical Science Building, Newark, NJ 11203USA
  4. 4.Department of Biostatistics, School of Tropical Medicine, Tulane University Health Sciences Center, 1440 Canal Street, New Orleans, LA 70112USA
  5. 5.Present address: Department of Urology, Humboldt University, Charité, Schumanstrasse 20–22, 10117 BerlinGermany

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