Renal Tumor Biopsy for Small Renal Masses: A Single-center 13-year Experience

Richard, Patrick O.; Jewett, Michael A.S.; Bhatt, Jaimin R.; Kachura, John R.; Evans, Andrew; Zlotta, Alexandre R.; Hermanns, Thomas; Juvet, Tristan; Finelli, Antonio

doi:10.1016/j.eururo.2015.04.004

Cited by 247 publications

(162 citation statements)

References 26 publications

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“…There were 15 core biopsy studies that used 18G needles. 5,13,15,16,18,20,21,[23][24][25][26][27][28][29][30] Eleven studies included biopsies performed using multiple imaging modalities (primarily CT or ultrasound). Radiation exposure from CT guidance occurred in 44.3%.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies specifically referenced Clavien grading. 5,16,30 One study found Clavien 1 complications in 10.1% and a single Clavien 3a complication (0.3%). 16 The Clavien 3a complication involved gross hematuria leading to urinary retention due to the formation of clots.…”

Section: Direct Adverse Eventsmentioning

confidence: 99%

“…2). 5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] One evaluated FNA with cytopathology alone 12 and all other studies evaluated core needle biopsy with surgical pathology. There were 15 core biopsy studies that used 18G needles.…”

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confidence: 99%

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Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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Purpose-Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. (January 1997 to May 2015 for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Materials and Methods-MEDLINE®, Embase® and the Cochrane databases were searchedResults-A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (~80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%).Conclusions-Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility. *Correspondence: 600 N. Wolfe St., Park Building, Room 223, Baltimore, Maryland 21207 (telephone: 610-534-4942; FAX: 410-502-7711; hitenpatel@jhmi.edu). No direct or indirect commercial incentive associated with publishing this article. Editor's Note:This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1628 and 1629. HHS Public Access MATERIALS AND METHODSThe methods of this systematic review follow the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews. 9 In an open process representatives of various stakeholder groups developed Key Questions, which are posted on the AHRQ web site for public comments (www.effectivehealthcare.ahrq.gov). The final review protocol was registered on PROSPERO (CRD42015015878, fig. 1). MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from January 1, 1997 through May 1, 2015.The systematic review focused on 3 major topics, of which 1 topic included 2 questions on renal mass sampling for masses suspicious for stage I or II RCC. 1) What is the accuracy (eg sensitivit...

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Section: Resultsmentioning

confidence: 99%

Section: Direct Adverse Eventsmentioning

confidence: 99%

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Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

et al. 2016

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“…Additionally, needle core biopsy has been shown to decrease overtreatment rates when used in the management of solid small renal masses. 80,81 However, its role in the management of cystic renal masses is not clearly defined.…”

Section: Role Of Renal Tumour Biopsy In the Management Of Cystic Lesionsmentioning

confidence: 99%

“…79,80 RTB is safe, accurate, and reliable. Additionally, needle core biopsy has been shown to decrease overtreatment rates when used in the management of solid small renal masses.…”

Section: Role Of Renal Tumour Biopsy In the Management Of Cystic Lesionsmentioning

confidence: 99%

CUA guideline on the management of cystic renal lesions

Richard¹,

Violette²,

Jewett³

et al. 2017

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Regional Variation of Computed Tomographic Imaging in the United States and the Risk of Nephrectomy

et al. 2018

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IMPORTANCE While computed tomography (CT) represents a tremendous advance in diagnostic imaging, it also creates the problem of incidental detection-the identification of tumors unrelated to the clinical symptoms that initiate the test.OBJECTIVE To determine the geographic variation in the United States in CT imaging and the corresponding association with one of the most consequential sequelae of incidental detection: nephrectomy. DESIGN, SETTING, AND PARTICIPANTSThis study is a cross-sectional analysis of age-, sex-, and race-adjusted Medicare data (January 2010-December 2014) from 306 hospital referral regions (HRRs) in the United States and includes information from 15 million fee-for-service Medicare beneficiaries age 65 to 85 years.EXPOSURES Regional CT risk (ie, the proportion of the population receiving either a chest or abdominal CT over 5 years). MAIN OUTCOMES AND MEASURES Five-year risk of nephrectomy (partial or total).RESULTS Data from 15 million fee-for-service Medicare beneficiaries age 65 to 85 years were gathered and illustrate that 43% of Medicare beneficiaries age 65 to 85 years received either a chest or abdominal CT from January 2010 to December 2014. This risk varied across the HRRs, ranging from 31% in Santa Cruz, California, to 52% in Sun City, Arizona. Increased regional CT risk was associated with a higher nephrectomy risk (r = 0.38; 95% CI, 0.28-0.47), particularly among HRRs with more than 50 000 beneficiaries (r = 0.47; 95% CI, 0.31-0.61). After controlling for HRR adult smoking rates, imaging an additional 1000 beneficiaries was associated with 4 additional nephrectomies (95% CI, 3-5). Case-fatality rates for those who underwent nephrectomy were 2.1% at 30 days and 4.3% at 90 days.CONCLUSIONS AND RELEVANCE Fee-for-service Medicare beneficiaries are commonly exposed to CT imaging. Those residing in high-scanning regions face a higher risk of nephrectomy, presumably reflecting the incidental detection of renal masses. Additional surgery should be considered one of the risks of excessive CT imaging.

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Renal Tumor Biopsy for Small Renal Masses: A Single-center 13-year Experience

Cited by 247 publications

References 26 publications

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

CUA guideline on the management of cystic renal lesions

Regional Variation of Computed Tomographic Imaging in the United States and the Risk of Nephrectomy

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