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

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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.

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References

  1. Frank I, Blute ML, Cheville JC, et al. (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170:2217–2220

    Article  PubMed  Google Scholar 

  2. Schmidbauer J, Remzi M, Memarsadeghi M, et al. (2008) Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol 53:1003–1012

    Article  PubMed  Google Scholar 

  3. Richter F, Kasabian NG, Irwin RJ Jr, et al. (2000) Accuracy of diagnosis by guided biopsy of renal mass lesions classified indeterminate by imaging. Urology 55:348–352

    Article  PubMed  CAS  Google Scholar 

  4. Haubek A, Lundarf E, Laurisden KN (1991) Diagnostic strategy in renal mass lesions. Scand J Urol Nephrol 137:35–39

    CAS  Google Scholar 

  5. Siegel R, Naishadham D, Ahmedin J (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  6. Young JR, Margolis D, Sauk S, et al. (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 267:444–453

    Article  PubMed  Google Scholar 

  7. Maturen KE, Nghiem HV, Caoili EM, et al. (2007) Renal mass core biopsy: accuracy and impact on clinical management. AJR 188:563–570

    Article  PubMed  Google Scholar 

  8. Herts BR, Baker ME (1995) The current role of percutaneous biopsy in the evaluation of renal masses. Semin Urol Oncol 13:254–261

    PubMed  CAS  Google Scholar 

  9. Herts BR (2003) Imaging for renal tumors. Curr Opin Urol 13:181–186

    Article  PubMed  Google Scholar 

  10. Volpe A, Terrone C, Scarpa RM (2009) The current role of percutaneous needle biopsies of renal tumours. Arch Ital Urol Androl 81:107–112

    PubMed  Google Scholar 

  11. Lane BR, Samplaski MK, Herts BR, et al. (2008) Renal mass biopsy: a renaissance? J Urol 179:20–27

    Article  PubMed  Google Scholar 

  12. Brierly RD, Thomas PJ, Harrison NW, et al. (2000) Evaluation of fine-needle aspiration cytology for renal masses. BJU Int 85:14–18

    Article  PubMed  CAS  Google Scholar 

  13. Campbell SC, Novick AC, Herts B, et al. (1997) Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity. Urology 50:25–29

    Article  PubMed  CAS  Google Scholar 

  14. Dechet CB, Zincke H, Sebo TJ, et al. (2003) Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 169:71–74

    Article  PubMed  Google Scholar 

  15. Wolf JS (1998) Evaluation and management of solid and cystic renal masses. J Urol 159:1120–1133

    Article  PubMed  Google Scholar 

  16. Cardella JF, Bakal CW, Bertino RE, et al. (2003) Quality improvement guidelines for image-guided percutaneous biopsy of adults. J Vasc Interv Radiol 14:S227–S230

    Article  PubMed  Google Scholar 

  17. Wood BJ, Khan MA, McGovern F, et al. (1999) Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. J Urol 161:1470–1474

    Article  PubMed  CAS  Google Scholar 

  18. Rybicki FJ, Shu KM, Cibas ES, et al. (2002) Percutaneous biopsy of renal masses: sensitivity and negative predicative value stratified by clinical setting and size of masses. AJR 180:1281–1287

    Article  Google Scholar 

  19. Harisinghani MG, Maher MM, Gervais DA, et al. (2003) Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? AJR. 180:755–758

    Article  PubMed  Google Scholar 

  20. Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C (2004) Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 171:1802–1805

    Article  PubMed  Google Scholar 

  21. DeRoche T, Walker E, Magi-Galluzzi C, Zhou M (2008) Pathologic characteristics of solitary small renal masses: can they be predicted by preoperative clinical parameters? Am J Clin Pathol 130:560–564

    Article  PubMed  Google Scholar 

  22. Shah RB, Bakshi N, Hafez KS, et al. (2005) Image-guided biopsy in the evaluation of renal mass lesions in contemporary urological practice: indications, adequacy, clinical impact, and limitations of the pathological diagnosis. Human Pathol. 36:1309–1315

    Google Scholar 

  23. Lebret T, Poulain JE, Molinie V, et al. (2007) Percutaneous core biopsy for renal masses: indications, accuracy and results. J Urol 178:1184–1188

    Article  PubMed  Google Scholar 

  24. Barocas DA, Mathew S, DelPizzo JJ, et al. (2006) Renal cell carcinoma sub-typing by histopathology and fluorescence in situ hybridization on a needle-biopsy specimen. BJU 99:290–295

    Article  Google Scholar 

  25. Gattuso P, Ramzy I, Truong LD, et al. (1999) Utilization of fine-needle aspiration in the diagnosis of metastatic tumors to the kidney. Diagn Cytopathol 21:35–38

    Article  PubMed  CAS  Google Scholar 

  26. Renshaw AA, Lee KR, Madge R, et al. (1997) Accuracy of fine-needle aspiration in distinguishing subtypes of renal cell carcinoma. Acta Cytol 41:987–994

    Article  PubMed  CAS  Google Scholar 

  27. Barocas DA, Rohan SM, Kao J, et al. (2006) Diagnosis of renal tumors on needle biopsy specimens by histological and molecular analysis. J Urol 176:1957–1962

    Article  PubMed  CAS  Google Scholar 

  28. Cozens NJ, Murchison JT, Allan PL (1992) Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided springloaded 18 G needle biopsy. Br J Radiol 65:594–597

    Article  PubMed  CAS  Google Scholar 

  29. Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES (2006) Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 240:6–22

    Article  PubMed  Google Scholar 

  30. Vasudevan A, Davies RJ, Shannon BA, Cohen RJ (2006) Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy. BJUI 97:946–949

    Article  Google Scholar 

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Authors and Affiliations

  1. The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Nisha Alle, Nelly Tan & Steven S. Raman

  2. The Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Allan Pantuck & Steven S. Raman

  3. The Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Julie Huss

  4. The Department of Pathology, Duke University School of Medicine, Durham, NC, USA

    Jiatoi Huang

  5. Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, 90095-7437, USA

    Nisha Alle

Authors
  1. Nisha Alle
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  2. Nelly Tan
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  3. Julie Huss
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  5. Allan Pantuck
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  6. Steven S. Raman
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Corresponding author

Correspondence to Nisha Alle.

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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.

Additional information

Institutional Review Board approval was obtained for this HIPAA-compliant retrospective study.

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Cite this article

Alle, N., Tan, N., Huss, J. et al. Percutaneous image-guided core biopsy of solid renal masses: analysis of safety, efficacy, pathologic interpretation, and clinical significance. Abdom Radiol 43, 1813–1819 (2018). https://doi.org/10.1007/s00261-017-1337-7

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  • DOI: https://doi.org/10.1007/s00261-017-1337-7

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