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

Abstract

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.

Tumor Seeding after Renal Mass Biopsy: is it Something to Worry About? A Case Report and Literature Review

“…This data aligns with the historical incidence of 0.01% described in the 1990s [7]. two recent case series reported higher frequencies of 1.2% and 6%, when cancer seeding was systematically searched on histological specimens after surgical resection [8,9]. Notably, among the 13 cases described by combining the two mentioned series, only one developed clinically manifested tumour recurrence at the site of the previous biopsy [8,9].…”

“…two recent case series reported higher frequencies of 1.2% and 6%, when cancer seeding was systematically searched on histological specimens after surgical resection [8,9]. Notably, among the 13 cases described by combining the two mentioned series, only one developed clinically manifested tumour recurrence at the site of the previous biopsy [8,9]. To the best of our knowledge, only 25 cases of tumor seeding after percutaneous renal mass biopsy have been reported so far, with half of them belonging to the two histological case series described above [8,9].…”

“…Notably, among the 13 cases described by combining the two mentioned series, only one developed clinically manifested tumour recurrence at the site of the previous biopsy [8,9]. To the best of our knowledge, only 25 cases of tumor seeding after percutaneous renal mass biopsy have been reported so far, with half of them belonging to the two histological case series described above [8,9]. Most of the cases involve papillary renal carcinomas, which however, account only for 15-20% of renal malignancies [1,8,10].…”

A unique case of chromophobe renal cell carcinoma seeding after biopsy

“…In contemporary literature, several case studies and small series have reported on histologically proven RTB tract seeding. 3 , 4 Most of these cases were ccRCC and pRCC. We present a unique case of tumor cell seeding of chRCC following two RTBs prior to radical nephrectomy, as tumor characteristics were not clear if malignant or benign.…”

“… 1 In a similar study, Zhou et al examined 98 cases who had both an RTB and underwent nephrectomy, of which six patients (6%) had pathological needle tract tumour seeding within the perinephric adipose; nevertheless, no patient in this cohort developed a classic local recurrence along the needle tract biopsy. 4 According to published literature, most recurrences following RTB are located in the perinephric fat and posterior abdominal wall with ccRCC and pRCC as the most common reported histopathologies. To the best of our knowledge, no cases of chRCC needle tract seeding have been reported.…”