Percutaneous Biopsy of Primary Tumor in Metastatic Renal Cell Carcinoma to Predict High Risk Pathological Features: Comparison With Nephrectomy Assessment

Abstract

PURPOSE As treatment options evolve in metastatic renal cell carcinoma (mRCC), there is need for predictive information to help guide therapy. The purpose of this study was to assess accuracy of percutaneous primary tumor biopsy in mRCC by comparing biopsy findings to final nephrectomy pathology in patients undergoing cytoreductive nephrectomy (CN). MATERIALS AND METHODS Using an institutional database, we reviewed records of patients who underwent percutaneous primary tumor biopsy prior to CN. For patients who underwent biopsy at an outside institution, pathology was re-reviewed at our institution. Differences in accuracy based on biopsy technique, imaging modality, and biopsy time period were determined using chi-square analysis. RESULTS We identified 166 patients who underwent percutaneous biopsy of the primary tumor prior to CN between 1991 and 2007 and had data available for review. Median pathologic tumor size was 9.1 cm (range 3–32). Median time from biopsy to surgery was 46 days (range 6–717). Of 104 patients whose biopsy was assigned a Fuhrman nuclear grade, 33 (31.7%) had the same grade in the nephrectomy specimen or 74 of 109 (67.9%) when only high or low grade was considered. Grade change by more than 2 points was seen in 18 of 104 (17.3%) patients. Sarcomatoid features were present in 34 of 166 (20.5%) nephrectomy specimens, however only 4 (11.8%) were identified pre-operatively. CONCLUSIONS In patients with mRCC, percutaneous renal biopsy has poor accuracy for assessment of Fuhrman nuclear grade or sarcomatoid features. Physicians should use caution when using biopsy data to guide therapy.

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

“…Percutaneous renal tumour biopsies are increasingly being used (1) for histological diagnosis of radiologically indeterminate RMs to avoid surgery in the event of benign lesions; (2) to select patients with small RMs for surveillance approaches; (3) to obtain histology before ablative treatments; and (4) to select the most suitable medical and surgical treatment strategy in the setting of mRCC (LE 3) [27][28][29]. Needle core biopsies are preferable for solid RMs in comparison with fine needle aspiration (LE 2b).…”

Evaluating the role for renal biopsy in T1 and T2 renal masses: A single-centre study

“…Fuhrman grade characterization remains highly variable however, both in our series and throughout the literature. 19 This is believed to be in large part due to the grade heterogeneity observed in renal masses. 20 The concern regarding adverse events has been dampened with experience and evidence supporting low complication rates throughout the literature.…”

Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus

“…Abel and colleagues assessed over 400 biopsy specimens in patients with metastatic disease. 44 They found that in 26.8% of cases, a biopsy of metastatic sites showed unspecified cancer that could not confirm RCC. Overall, RCC was clearly identified in only 65% of cases.…”

“…An identical grade may be found in 32% to 70% of cases. 33,43,44 In the case of a non-diagnostic initial biopsy, it may be …”