Renal Mass Biopsy—A Renaissance?

Lane, Brian R.; Samplaski, Mary K.; Herts, Brian R.; Zhou, Ming; Novick, Andrew C.; Campbell, Steven C.

doi:10.1016/j.juro.2007.08.124

Cited by 293 publications

(251 citation statements)

References 47 publications

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“…Determining the oncologic potential of small renal tumors, including the use of renal mass biopsy, might provide information that would enable physicians and patients to select less invasive treatments, such as surveillance or tumor ablation, and to reserve surgical intervention for the small proportion of patients who have potentially aggressive tumors. 11 The value of renal mass biopsy and/or radiographic testing that incorporates molecular diagnostic tools, such as those that detect carbonic anhydrase IX expression (which is limited to the more aggressive, clear cell variant of RCC) in this patient population warrants further investigation. 11,24 The lack of treatment effect in the current study also may be related to off-setting effects with oncologic benefit and renal-functional detriment to surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

“…11 The value of renal mass biopsy and/or radiographic testing that incorporates molecular diagnostic tools, such as those that detect carbonic anhydrase IX expression (which is limited to the more aggressive, clear cell variant of RCC) in this patient population warrants further investigation. 11,24 The lack of treatment effect in the current study also may be related to off-setting effects with oncologic benefit and renal-functional detriment to surgical approaches. Our data confirmed earlier data associating decreased renal function with an increased risk of cardiovascular death, 10 which is the leading cause of mortality in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…11 To investigate the impact of information that potentially could be obtained from renal mass biopsy, we added histologic tumor type (clear cell RCC, other cancer, or benign) and predicted oncologic activity (potentially aggressive, indolent, or benign) based on adding final surgical pathology to the model. Neither was associated significantly with overall survival after accounting for all other variables (P ¼ .75 and P ¼ .61, respectively).…”

Section: Overall Survivalmentioning

confidence: 99%

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Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Lane

Abouassaly

Gao

et al. 2010

Cancer

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233

138

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BACKGROUND: Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors 7 cm detected at age 75 years to investigate whether surgical intervention improved survival compared with active surveillance. METHODS: Clinical T1 renal tumors were managed with surveillance (20%), nephron-sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables. RESULTS: The median follow-up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan-Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron-sparing intervention (P ¼ .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P ¼ .0004) and comorbidity (P < .0001) but not management type (P ¼ .3). Preoperative renal function (P ¼ .006) and comorbidity (P ¼ .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function. CONCLUSIONS: In patients aged 75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010;116:3119-26.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Overall Survivalmentioning

confidence: 99%

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Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Lane

Abouassaly

Gao

et al. 2010

Cancer

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233

138

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“…9 Complications associated with percutaneous renal biopsy include hemorrhage, infection, pneumothorax, development of an arteriovenous fistula, and percutaneous tract tumor seeding. 10,11 In our cohort of patients, there were no complications noted immediately after the renal biopsy. In our series, as in many recent series, renal mass biopsy was performed with core needle biopsy (14 to 21 gauge).…”

Section: Accuracy and Implications Of Percutaneous Renal Biopsy In Thmentioning

confidence: 59%

Accuracy and Implications of Percutaneous Renal Biopsy in the Management of Renal Masses

Londoño

Wuerstle²,

Thomas³

et al. 2013

TPJ

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“…El 5,2% y el 3,8% de las biopsias fueron insuficientes o indeterminadas respectivamente. En el 0,6% se produjeron falsos negativos y las complicaciones mayores fueron el 0,3% 23 .…”

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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Renal Mass Biopsy—A Renaissance?

Cited by 293 publications

References 47 publications

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

Accuracy and Implications of Percutaneous Renal Biopsy in the Management of Renal Masses

Biopsia de masas renales: resultados y seguridad en 2009

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