Renal mass core biopsy: accuracy and impact on clinical management.

  • Maturen K
  • Nghiem H
  • Caoili E
 et al. 
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Abstract

OBJECTIVE: The objective of our study was to determine the accuracy of imaging-guided percutaneous renal mass biopsy and its impact on clinical management.

MATERIALS AND METHODS: With institutional review board approval, we retrospectively reviewed imaging-guided renal biopsies performed by radiologists at our institution between February 1999 and July 2005. Patient records, pathology reports, and imaging studies were reviewed. Concordance of biopsy diagnosis and follow-up data was assessed. Significant impact on clinical management was determined in collaboration with two experienced urologists and was defined as a change from no therapy to therapy, including surgery, tumor ablation, chemotherapy, or radiation.

RESULTS: Two hundred seventy-six renal biopsies were performed during the study period. Of these, 123 were random biopsies and fine-needle technique was used for one; these 124 were excluded. One hundred fifty-two renal mass biopsies were performed using coaxial 18-gauge core needle technique in 125 patients (55 women, 70 men; average age, 60 years; range, 28-90 years). There were two (1.3%) postprocedural hematomas (one [0.7%] requiring blood transfusion) and one (0.7%) delayed renal pseudoaneurysm attributed to biopsy. No tumor seeding was identified. In 85 biopsies (56%), malignant neoplasm was found, 61 biopsies (40%) yielded benign findings, and six (4%) were nondiagnostic. The sensitivity for malignancy was 97.7%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 100%. At least 92 (60.5%) biopsy results significantly impacted clinical management.

CONCLUSION: Imaging-guided percutaneous core needle biopsy of renal masses is safe and highly accurate. Tissue diagnosis alters clinical decision making in a majority of the cases and may allow a number of unnecessary nephrectomies to be avoided.

Author-supplied keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Biopsy, Needle: methods
  • Female
  • Humans
  • Kidney
  • Kidney Neoplasms
  • Kidney Neoplasms: diagnosis
  • Kidney Neoplasms: pathology
  • Kidney: pathology
  • Kidney: radiography
  • Kidney: ultrasonography
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Surgery, Computer-Assisted
  • Surgery, Computer-Assisted: methods

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Authors

  • Katherine E Maturen

  • Hanh V Nghiem

  • Elaine M Caoili

  • Ellen G Higgins

  • J Stuart Wolf

  • David P Wood

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