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Real-Time 3D Fluoroscopy-Guided Large Core Needle Biopsy of Renal Masses: A Critical Early Evaluation According to the IDEAL Recommendations

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Abstract

Introduction

Three-dimensional (3D) real-time fluoroscopy cone beam CT is a promising new technique for image-guided biopsy of solid tumors. We evaluated the technical feasibility, diagnostic accuracy, and complications of this technique for guidance of large-core needle biopsy in patients with suspicious renal masses.

Methods

Thirteen patients with 13 suspicious renal masses underwent large-core needle biopsy under 3D real-time fluoroscopy cone beam CT guidance. Imaging acquisition and subsequent 3D reconstruction was done by a mobile flat-panel detector (FD) C-arm system to plan the needle path. Large-core needle biopsies were taken by the interventional radiologist. Technical success, accuracy, and safety were evaluated according to the Innovation, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations.

Results

Median tumor size was 2.6 (range, 1.0–14.0) cm. In ten (77%) patients, the histological diagnosis corresponded to the imaging findings: five were malignancies, five benign lesions. Technical feasibility was 77% (10/13); in three patients biopsy results were inconclusive. The lesion size of these three patients was <2.5 cm. One patient developed a minor complication. Median follow-up was 16.0 (range, 6.4–19.8) months.

Conclusions

3D real-time fluoroscopy cone beam CT-guided biopsy of renal masses is feasible and safe. However, these first results suggest that diagnostic accuracy may be limited in patients with renal masses <2.5 cm.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, University Medical Center Utrecht, C04.236, Postbox 85500, 3508 GA, Utrecht, The Netherlands

    Stephanie G. C. Kroeze & J. L. H. Ruud Bosch

  2. Department of Radiology, University Medical Center Utrecht, F 01.503, Postbox 85500, 3508 GA, Utrecht, The Netherlands

    Merel Huisman, Helena M. Verkooijen & Maurice A. A. J. van den Bosch

  3. Department of Pathology, University Medical Center Utrecht, 04.312, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Paul J. van Diest

Authors
  1. Stephanie G. C. Kroeze
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  2. Merel Huisman
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  3. Helena M. Verkooijen
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  4. Paul J. van Diest
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  5. J. L. H. Ruud Bosch
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  6. Maurice A. A. J. van den Bosch
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Correspondence to Maurice A. A. J. van den Bosch.

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Kroeze, S.G.C., Huisman, M., Verkooijen, H.M. et al. Real-Time 3D Fluoroscopy-Guided Large Core Needle Biopsy of Renal Masses: A Critical Early Evaluation According to the IDEAL Recommendations. Cardiovasc Intervent Radiol 35, 680–685 (2012). https://doi.org/10.1007/s00270-011-0237-4

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  • DOI: https://doi.org/10.1007/s00270-011-0237-4

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