<b>Incidence of Malignancy in Complex Cystic Renal Masses (Bosniak  Category III):</b> Should Imaging-Guided Biopsy Precede Surgery?

Harisinghani, Mukesh G.; Maher, Michael M.; Gervais, Debra A.; McGovern, Francis J.; Hahn, Peter F.; Jhaveri, Kartik; Varghese, Jose C.; Müeller, Peter R.

doi:10.2214/ajr.180.3.1800755

Cited by 172 publications

(80 citation statements)

References 9 publications

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“…2). 5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] One evaluated FNA with cytopathology alone 12 and all other studies evaluated core needle biopsy with surgical pathology. There were 15 core biopsy studies that used 18G needles.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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Purpose-Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. (January 1997 to May 2015 for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Materials and Methods-MEDLINE®, Embase® and the Cochrane databases were searchedResults-A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (~80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%).Conclusions-Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility. *Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21207 (telephone: 610-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article. Editor's Note:This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1628 and 1629. HHS Public Access MATERIALS AND METHODSThe methods of this systematic review follow the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews. 9 In an open process representatives of various stakeholder groups developed Key Questions, which are posted on the AHRQ web site for public comments (www.effectivehealthcare.ahrq.gov). The final review protocol was registered on PROSPERO (CRD42015015878, fig. 1). MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1, 1997 through May 1, 2015.The systematic review focused on 3 major topics, of which 1 topic included 2 questions on renal mass sampling for masses suspicious for stage I or II RCC. 1) What is the accuracy (eg sensitivit...

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Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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“…Nevertheless, there is literature supporting the role of RTB for histology identification of Bosniak III and IV cysts. 28,74,75,82 It is generally felt that RTB is not diagnostic for most Bosniak III cysts, as there is minimal targetable solid component. (Level of evidence: 3; Recommendation: D) For Bosniak IV cysts, a biopsy of the solid component may be considered to confirm the presence of a malignant tumour and to help with decisionmaking in select cases (elderly, multiple comorbidities, unfit for treatment, etc).…”

Section: Role Of Renal Tumour Biopsy In the Management Of Cystic Lesionsmentioning

confidence: 99%

“…(Level of evidence: 3; Recommendation: D) For Bosniak IV cysts, a biopsy of the solid component may be considered to confirm the presence of a malignant tumour and to help with decisionmaking in select cases (elderly, multiple comorbidities, unfit for treatment, etc). 5,28,74,75,82,83 (Level of evidence: 3; Recommendation: C) Of interest, some reports have suggested that the combination of fine needle aspiration (FNA) and core biopsy may lead to a slightly higher diagnostic yield than core biopsy alone. 85 Nevertheless, in most centres of experience, RTBs are performed using core biopsy alone, as the combination is thought to add minimal value.…”

Section: Role Of Renal Tumour Biopsy In the Management Of Cystic Lesionsmentioning

confidence: 99%

CUA guideline on the management of cystic renal lesions

Richard¹,

Violette²,

Jewett³

et al. 2017

CUAJ

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“…Indications for renal biopsy remains restricted to Bosniak IV cysts with a tissue target clearly visible on imaging. 7 Harisinghani et al 7 report that a combination of biopsy and fine needle aspiration of cyst could prevent 40% of unnecessary surgery for Bosniak III cysts. In a series of 199 biopsies associated with a needle puncture for IIF and III lesions , Lang et al 1 found a positive predictive value of 91% for malignancy and 100% for benign lesions.…”

Section: Contrast Enhanced Ultrasound Of the Kidney (Ceus)mentioning

confidence: 99%

Renal Cancer Mimicking a Renal Cyst: A Case Report

Aboubakry¹,

Tenkorang²,

Tazi³

et al. 2017

Urol Androl Open J

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Introduction:Renal cystic diseases are common and are often less aggressive and benign in nature. Watchful waiting is the therapeutic choice for managing simple renal cysts. Some malignant tumors of the kidney may have features of a benign renal cyst. It is challenging to determine how to manage such affections of the kidney. Very few of these cases have been reported in the literature but do not have a standard therapeutic approach. The objective of this case presentation is to discuss useful ways in managing renal cancer presenting as a renal cyst. Case presentation: A 78-year-old moroccan male farmer with no significant medical history presented with a 2 year intermittent left flank pain. Physical examination was unremarkable. Ultrasound and computed tomography (CT) scan found multiple simple renal cysts including one suspected renal cyst. A radical nephrectomy was performed. Anatomopathological studies of the specimen confirmed a renal cancer. Conclusion: We emphasize on the importance of thorough imaging studies for cystic affections of the kidney as the least feature of malignancy should be considered in its therapeutic management. We recommend surgery as a justified therapeutic approach in managing cystic renal lesions when there is a suspicion of malignancy.

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Incidence of Malignancy in Complex Cystic Renal Masses (Bosniak Category III): Should Imaging-Guided Biopsy Precede Surgery?

Abstract: Renal biopsy and radiologic follow-up were useful in identifying nonmalignant lesions in complex cystic renal masses and avoided unnecessary surgery in 39% of patients.

Cited by 172 publications

References 9 publications

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

CUA guideline on the management of cystic renal lesions

Renal Cancer Mimicking a Renal Cyst: A Case Report

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