Historically, patients with small renal masses have not routinely undergone percutaneous biopsy before proceeding to surgical extirpation, partly due to concerns of biopsy inaccuracy, needle track seeding, and minimal change in clinical management. However, contemporary improvements in technique and cross-sectional imaging have led to increased diagnostic sufficiency and accuracy of renal biopsy. Major complications are rare. Most importantly, a large proportion of small renal masses biopsied are, in fact, benign, and biopsy has the potential to change clinical management and help patients avoid unnecessary surgical extirpation. Image-guided percutaneous core biopsy should be incorporated into the diagnosis and management of enhancing small renal masses.
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