Needle track seeding in renal mass biopsies

Renshaw, Andrew A.; Powell, Alex; Caso, Jorge; Gould, Edwin W.

doi:10.1002/cncy.22147

Cited by 18 publications

(16 citation statements)

References 43 publications

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“…Some studies observed that PRCC tend to exhibit incomplete or absent peritumoral pseudo-capsule more frequently than CCRCC, facilitating tumor invasion into the perinephric fat [ 23 ]. Other hypotheses for higher rate of needle tract tumor seeding in PRCC include the friable nature of the tumor facilitating tumor cell adherence to the needle, higher frequency of exophytic growth allowing tumor seeding more often in the extrarenal space, as well as possible higher chance of tumor cell survival when explanted into the needle tract [ 17 ]. Nevertheless, the exact reasons for the differences in the frequencies of biopsy needle tract tumor seeding among various pathologic types of renal tumors need further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…To date, only a handful of case reports and a small case series have been published [8,[11][12][13][14][15][16]. However, the frequency and clinical significance of biopsy-associated tumor seeding remains largely controversial due at least in part to lack of systemic review, histological analysis and follow up data in early studies [9,10,17]. In recent years, a few studies re-visited the phenomenon of tumor seeding along core needle biopsy tract in renal cell carcinomas and challenged the previously acknowledged rarity of needle tract tumor seeding following renal tumor biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Needle tract seeding in renal tumor biopsies: experience from a single institution

Zhou

Murugan

et al. 2021

Diagn Pathol

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Background Percutaneous needle biopsy of renal masses has been increasingly utilized to aid the diagnosis and guide management. It is generally considered as a safe procedure. However, tumor seeding along the needle tract, one of the complications, theoretically poses potential risk of tumor spread by seeded malignant cells. Prior studies on the frequency of needle tract seeding in renal tumor biopsies are limited and clinical significance of biopsy-associated tumor seeding remains largely controversial. Methods Here we investigated the frequencies of biopsy needle tract tumor seeding at our institution by reviewing the histology of renal cell carcinoma nephrectomy specimens with a prior biopsy within the last seventeen years. Biopsy site changes were recognized as a combination of foreign body reaction, hemosiderin deposition, fibrosis and fat necrosis. The histologic evidence of needle tract tumor seeding was identified as clusters of tumor cells embedded in perinephric tissue spatially associated with the biopsy site. In addition, association between parameters of biopsy techniques and tumor seeding were investigated. Results We observed needle tract tumor seeding to perinephric tissue in six out of ninety-eight (6 %) renal cell carcinoma cases including clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe, and clear cell papillary renal cell carcinoma. The needle tract tumor seeding was exclusively observed in papillary renal cell carcinomas (6/28, 21 %) that were unifocal, small-sized (≤ 4 cm), confined to the kidney and had type 1 features. No recurrence or metastasis was observed in the papillary renal cell carcinoma cases with tumor seeding or the stage-matched cases without tumor seeding. Conclusions Our study demonstrated a higher than reported frequency of needle tract tumor seeding. Effective communication between pathologists and clinicians as well as documentation of tumor seeding is recommended. Further studies with a larger patient cohort and longer follow up to evaluate the impact of needle tract tumor seeding on long term prognosis are needed. This may also help reach a consensus on appropriate pathologic staging of renal cell carcinoma when the only site of perinephric fat invasion is within a biopsy needle tract.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Needle tract seeding in renal tumor biopsies: experience from a single institution

Zhou

Murugan

et al. 2021

Diagn Pathol

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“…However, cases with involvement beyond perirenal tissue have been reported with the use of smaller needles, including a 23‐gauge needle, as well as with coaxial sheaths; therefore, BTS still occurs with needles of different sizes, with or without a coaxial sheath, and may account for the cases of BTS‐P in our institution, given that we use an 18‐gauge coaxial needle 16,19 . No cases of BTS have been identified when needles of <20 gauge and a coaxial sheath have been used, 26 and it seems that using both may eliminate the risk. However, because of insufficient data and the undetermined clinical significance of BTS beyond the adjacent tissues of the kidney, it is still unclear how to appropriately stage these tumours; these are aspects of BTS that were not addressed in this study.…”

Section: Discussionmentioning

confidence: 85%

“…Herein, we discuss only the significance of BTS‐P, as none of the cases in our cohort had involvement beyond the perinephric tissue. Although BTS is rare, its presence has been associated with the use of needles of ≥20 gauge, the lack of a coaxial sheath, and multiple passes of the renal mass 26,27 . However, cases with involvement beyond perirenal tissue have been reported with the use of smaller needles, including a 23‐gauge needle, as well as with coaxial sheaths; therefore, BTS still occurs with needles of different sizes, with or without a coaxial sheath, and may account for the cases of BTS‐P in our institution, given that we use an 18‐gauge coaxial needle 16,19 .…”

Section: Discussionmentioning

confidence: 94%

To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma

Valencia-Guerrero

Oliva

et al. 2021

Histopathology

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Aims Perinephric fat invasion (PFI) is a key component of renal cell carcinoma (RCC) staging, but there are limited data pertaining to biopsy tract seeding (BTS) resulting in perirenal tissue involvement [BTS with perinephric fat invasion (BTS‐P)].The aim is to correlate clinical outcomes with pathologic stage to determine whether the presence of BTS‐P should be considered a criterion to stage RCC as part of the pT3a category in the absence of any other upstaging variables. Materials and results We identified 304 renal biopsies from patients with subsequent nephrectomies for RCC; 33 of the tumours contained PFI. Each case was reviewed to determine the presence of BTS‐P and other forms of invasion [e.g. non‐BTS‐P PFI, sinus fat invasion (SFI), and/or renal vein invasion (RVI)], and these findings were compared with survival outcomes. Ten (30%) of 33 tumours with PFI showed BTS‐P as the only finding, and were otherwise pT1 tumours; six (60%) patients were alive without disease (AWOD) (mean, 77.5 months), three were lost to follow‐up (LTF), and one died of other disease (DOOD). Two patients showed true PFI plus BTS‐P; one was LTF and one is AWOD at 107 months. Ten (43%) of 23 patients with tumours with true invasion (PFI ± SFI and/or RVI) are AWOD (mean, 97.7 months), eight (35%) died of disease (DOD), four were LTF, and one DOOD. Kaplan–Meier survival curves showed that the cancer‐specific survival was significantly worse in patients with true invasion (P = 0.044) than in those with BTS‐P as the sole finding. Conclusion Patients with tumours showing BTS‐P only appear to have better outcomes than those with other non‐PFI invasion, suggesting that this finding should not be upstaged to pT3a. Additional studies are needed to corroborate the significance of our observations.

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“…4 These data also expand the list of benign renal lesions (oncocytoma, cystic nephroma, angiomyolipoma, and papillary adenoma [given the appropriate size]) that in at least some cases can be recognized on cytologic material alone. In many cases, these lesions can be confirmed with immunohistochemistry (IHC) performed on core needle biopsy, though large core needle biopsy of renal lesions has its drawbacks (most notably bleeding and needle track seeding 5 ).…”

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confidence: 99%

Should cytologists diagnose clear cell papillary renal cell carcinoma on cytologic material?

Renshaw

2020

Cancer Cytopathology

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Needle track seeding in renal mass biopsies

Cited by 18 publications

References 43 publications

Needle tract seeding in renal tumor biopsies: experience from a single institution

Needle tract seeding in renal tumor biopsies: experience from a single institution

To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma

Should cytologists diagnose clear cell papillary renal cell carcinoma on cytologic material?

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