Contemporary Results of Percutaneous Biopsy of 100 Small Renal Masses: A Single Center Experience

Volpe, Alessandro; Mattar, Kamal; Finelli, Antonio; Kachura, John R.; Evans, Andrew; Geddie, William R.; Jewett, Michael A.S.

doi:10.1016/j.juro.2008.08.014

Cited by 216 publications

(181 citation statements)

References 22 publications

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“…The reported accuracy of percutaneous biopsy of renal cortical tumors ranges from 70% to 90% (16)(17)(18)(19)(20), and recent advances in imaging and image-guided intervention, as well as cytologic, immunohistochemical, and molecular techniques, might further expand the role of percutaneous biopsy in the diagnosis of renal cortical tumors (20). However, widespread use of biopsy of renal cortical tumors has been controversial in the urology community owing to factors such as (a) the invasiveness and the potential complications of biopsy, (b) the possibility of sampling errors and the dependence on R enal cortical tumors represent a complex family of neoplasms with unique histopathologic features, cytogenetic defects, and variable clinical behaviors, ranging from the benign oncocytoma to indolent variants of papillary and chromophobe carcinomas to the more aggressive conventional clear cell The first postcontrast sequence was acquired 5 seconds after peak arterial enhancement, followed by 70 seconds after contrast material administration and 3-4 minutes after contrast material administration.…”

Section: Discussionmentioning

confidence: 99%

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Vargas

Chaim²,

Lefkowitz³

et al. 2012

Radiology

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Purpose:To investigate the use of quantitative multiphasic contrast material-enhanced magnetic resonance (MR) imaging in differentiating between common benign and malignant histologic subtypes of renal cortical tumors. Materials and Methods:The institutional review board waived informed consent and approved this retrospective HIPAA-compliant study of 138 patients who underwent preoperative contrastenhanced MR imaging during the period of January 2004-December 2008. At surgery, 152 renal tumors were identified (77 clear cell, 22 papillary, 18 chromophobe, and 10 unclassified carcinomas; 16 oncocytomas; nine angiomyolipomas). Three readers independently identified and measured the most-enhanced area in each tumor and placed corresponding regions of interest in similar positions on images from the precontrast, corticomedullary, nephrographic, and excretory phases. The percentage change in signal intensity (%SI change) between precontrast imaging and each postcontrast phase was calculated.Interreader agreement was evaluated by using the overall concordance correlation coefficient (OCC). A linear mixed-effects model was used to estimate and compare the trajectories of the means of log %SI change across all phases between the six histologic subtypes. results:Interreader agreement was substantial to almost perfect (OCC, 0.77-0.88). The %SI change differed significantly between clear cell carcinomas and papillary and chromophobe carcinomas in all phases of enhancement (P , .0001-.0120). In addition, %SI change was significantly higher in angiomyolipomas than in clear cell carcinomas, but only in the corticomedullary phase (P = .0231). Enhancement did not differ significantly between clear cell carcinoma and oncocytoma in any phase (P = .2081-.6000). conclusion:Quantitative multiphase contrast-enhanced MR imaging offers a widely available, reproducible method to characterize several histologic subtypes of renal cortical tumors, although it does not aid differentiation between clear cell carcinomas and oncocytomas.q RSNA, 20121 From the Departments of Radiology (H

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Section: Discussionmentioning

confidence: 99%

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Vargas

Chaim²,

Lefkowitz³

et al. 2012

Radiology

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“…Needle core biopsies are preferable for solid RMs in comparison with fine needle aspiration (LE 2b). Core biopsies should be performed with 18G needles and a coaxial technique to minimise the risk of complications and seeding (LE 2b) [28,30,31]. Either a US-or CT-guided approach can be used according to tumour and patient characteristics (LE 2b) [28,30].…”

Section: Renal Biopsymentioning

confidence: 99%

“…Either a US-or CT-guided approach can be used according to tumour and patient characteristics (LE 2b) [28,30]. At least two quality cores (nonfragmented, >10 mm in length) should be obtained, and necrotic areas should be avoided to maximise diagnostic accuracy (LE 4) [30,32]. Peripheral biopsies are preferable for larger tumours to avoid the central necrosis (LE 2b) [33].…”

Section: Renal Biopsymentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Ljungberg¹,

Bensalah²,

Canfield³

et al. 2015

European Urology

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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“…Además, en su estudio fue posible precisar el subtipo histológico y el grado en el 93% y el 68% respec- 26 . En un estudio similar, Wang et al han comunicado los resultados de 110 biopsias por masas renales de menos de 4 cm.…”

Section: Resultados Y Limitacionesunclassified

Biopsia de masas renales: resultados y seguridad en 2009

Gallego

Abarca

2009

Actas Urológicas Españolas

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E n los últimos años se ha producido un aumento en el interés por la biopsia de masas renales (BMR). El aumento en la incidencia de cáncer renal y especialmente de tumores de pequeño tamaño, consecuencia del incremento en la utilización de pruebas de imagen como el CT y RM 1-2 es probablemente uno de los motivos, pero también lo es la ampliación en los últimos años de las opciones de manejo de masas renales pequeñas, como las técni-cas de ablación térmica o la observación.El hallazgo incidental de masas renales de pequeño tamaño se ha convertido en un escenario clínico frecuente y en la actualidad se sabe que corresponde con un grupo heterogéneo de tumores que incluyen enfermedades malignas y benignas con comportamiento clínico diferente. Desde una perspectiva tradicional, las biopsias de masas renales presentaban una alta tasa de falsos negativos. Las limitaciones de la fiabilidad diagnóstica de las biopsias de masas renales se ha relacionado con la heterogeneidad histológica de los tumores renales, o con errores en la elección del sitio de punción (errores de muestreo) [3][4][5][6] . Pero también por el temor a las potenciales complicaciones o el asiento de células malignas en el sitio de punción [7][8][9][10][11][12] .Los urólogos han considerado hasta hace poco candidatas a cirugía todas las lesiones sólidas renales. Sin embargo recientes estudios que han revisado los resultados histopatológicos de piezas de nefrectomía parcial por tumores de pequeño tamaño han demostrado que la mayoría de las lesiones renales de pequeño tamaño presentan bajo grado histológico o características de escasa agresividad y por tanto podrían manejarse en determinados casos sin necesidad de cirugía 13,14 .En la actualidad, existen nuevos tratamientos dirigidos específicamente hacia dianas moleculares implicadas en el desarrollo de determinados subtipos ResumenEl papel de la biopsia de masas renales ha sido hasta ahora limitado por los resultados insatisfactorios en cuanto a fiabilidad diagnostica y por su escasa repercusión en las decisiones terapéuticas. Recientemente las BMR han recobrado interés entre los urólogos, debido al aumento de incidencia de tumores renales, la aparición de nuevas opciones de manejo y los avances en el diagnóstico histológico.Hemos revisado mediante una búsqueda en Pubmed, las publicaciones más relevantes sobre biopsias de tumores renales aparecidas en los últimos años.Los estudios clínicos más recientes demuestran un alto grado de fiabilidad diagnostica para diferenciar malignidad, tipo histológico y grado de las biopsias percutáneas de tumores renales, con una baja tasa de complicaciones asociadas. Sin embargo su utilización rutinaria continúa siendo controvertida y sus indicaciones limitadas dada la escasa capacidad de modificar la actitud terapéutica.Palabras clave: Cáncer renal. Biopsia. Diagnóstico. Renal mass biopsy: Results and safety in 2009 AbstractThe role of renal mass biopsies has been limited by suboptimal results in terms of diagnostic reliability, and their scant repercussion upon thera...

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Contemporary Results of Percutaneous Biopsy of 100 Small Renal Masses: A Single Center Experience

Cited by 216 publications

References 22 publications

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Biopsia de masas renales: resultados y seguridad en 2009

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