Percutaneous biopsy for risk stratification of renal masses

Abstract

Abstract:The increased use of abdominal imaging has led to identification of more patients with incidental renal masses, and renal mass biopsy (RMB) has become a popular method to evaluate unknown renal masses prior to definitive treatment. Pathologic data obtained from biopsy may be used to guide decisions for treatment and may include the presence or absence of malignant tumor, renal cell cancer subtype, tumor grade and the presence of other aggressive pathologic features. However, prior to using RMB for risk stratification, it is important to understand whether RMB findings are equivalent to pathologic analysis of surgical specimens and to identify any potential limitations of this approach. This review outlines the advantages and limitations of the current studies that evaluate RMB as a guide for treatment decision in patients with unknown renal masses. In multiple series, RMB has demonstrated low morbidity and a theoretical reduction in cost, if patients with benign tumors are identified from biopsy and can avoid subsequent treatment. However, when considering the routine use of RMB for risk stratification, it is important to note that biopsy may underestimate risk in some patients by undergrading, understaging or failing to identify aggressive tumor features. Future studies should focus on developing treatment algorithms that integrate RMB to identify the optimal use in risk stratification of patients with unknown renal masses.

Effect of Tumor Complexity and Technique on Efficacy and Complications after Percutaneous Microwave Ablation of Stage T1a Renal Cell Carcinoma: A Single-Center, Retrospective Study

“…Tumor histologic characteristics rather than technique likely explained the cause of the treatment failure. Histologic grading of RCC from renal mass biopsy is a well-known limitation, with concordance rates at extirpation ranging from 43% to 80% (25). Importantly, higher grade RCCs (Fuhrman grade III or IV) and RCCs with aggressive histologic characteristics (sarcomatoid or rhabdoid features) may require a larger margin when performing thermal ablation or may be more suited for surgical management.…”

The kidney cancer research priority-setting partnership: Identifying the top 10 research priorities as defined by patients, caregivers, and expert clinicians

“…Thus, future work is needed to debunk the current concerns of urologists regarding the use of RMBs in the management of SRMs 42 and to explore how RMBs can be integrated with treatment algorithms to inform risk stratification of patients with SRMs and aid in decision-making. 47,48 Recent advances in genetics and epigenetics has improved our understanding of kidney cancers and their clinical outcomes. Studies have shown that gene expression profiling is feasible on tissues 49,50 obtained through RBM.…”

World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading in fine‐needle aspiration biopsies of renal masses

“…1,7 Core biopsy has been shown to be a reliable diagnostic tool in the work-up of renal lesions in terms of assigning an accurate diagnosis. 5,[8][9][10][11][12] While some studies have indicated only moderate concordance between grade assignment on needle core biopsy and resection specimens, assignment of a nuclear grade to core biopsies is still common practice at many institutions including our own. 8,[11][12][13] In contrast, assignment of a nuclear grade is not routine for FNA biopsies from primary renal lesions.…”

“…5,[8][9][10][11][12] While some studies have indicated only moderate concordance between grade assignment on needle core biopsy and resection specimens, assignment of a nuclear grade to core biopsies is still common practice at many institutions including our own. 8,[11][12][13] In contrast, assignment of a nuclear grade is not routine for FNA biopsies from primary renal lesions. There are only a few studies which address the topic of assigning a nuclear grade to an FNA biopsy of a renal lesion in the literature, all of which indicate either moderate agreement with resection grade or moderate interobserver variability using a four tier grading system.…”