The Diagnostic Accuracy of Percutaneous Renal Needle Core Biopsy and Its Potential Impact on the Clinical Management of Renal Cortical Neoplasms

Abstract

Context While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. Objectives To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Design Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. Results In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Conclusions Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management.

Cytopathologic features of clear cell papillary renal cell carcinoma: A recently described variant to be considered in the differential diagnosis of clear cell renal epithelial neoplasms

“…31 It is helpful that the stroma of CCPRCC, recently confirmed to represent an entrapped polyclonal hyperplastic process rather An important caveat to these findings concerns an understanding of the limitations of sampling and the importance of correlation with the clinical and radiologic setting for making an assessment of CCPRCC (or any other RCC variant) with limited samples. Although contemporary morphologic assessments and immunohistochemical workup of cytologic and core biopsy samples have shown improved concordance with resection findings in recent series, 20,32 limitations remain, including the challenge of evaluating small samples of renal oncocytic neoplasms, which may show notoriously variable histologies. [32][33][34] Very recent data show that an infrequent subset of CCPRCCs may also have variable areas, with higher grade foci or even conventional CCRCC-like areas.…”

“…Although contemporary morphologic assessments and immunohistochemical workup of cytologic and core biopsy samples have shown improved concordance with resection findings in recent series, 20,32 limitations remain, including the challenge of evaluating small samples of renal oncocytic neoplasms, which may show notoriously variable histologies. [32][33][34] Very recent data show that an infrequent subset of CCPRCCs may also have variable areas, with higher grade foci or even conventional CCRCC-like areas. 35,36 Although the prognostic and therapeutic significance of such findings remains to be explored, we underscore that some features, particularly a large size with a significant solid component or radiographic evidence of aggressive features (extrarenal extension and certainly any vascular involvement), would in our opinion preclude consideration of CCPRCC for cytologic or small biopsy samples.…”

Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10‐year retrospective review

“…The indications for biopsy are to rule out a non‐renal cell primary tumor, benign conditions (which may not require surgery), and to confirm the malignant diagnosis and histological subtype which will guide the oncologic approach and the post‐ablation risk adapted surveillance imaging protocols . With advancing biopsy techniques, the use of renal mass biopsy is recommended due to increased accuracy in interpretation (accurate diagnoses can be rendered in more than 90% of renal masses biopsied) and rare minor complications in less than 1% of cases . The risk of tumor seeding is extremely low (less than 0.01%), and the risk of bleeding is very rare, with most cases being self‐limiting …”

“…With advancing biopsy techniques, the use of renal mass biopsy is recommended due to increased accuracy in interpretation (accurate diagnoses can be rendered in more than 90% of renal masses biopsied) and rare minor complications in less than 1% of cases . The risk of tumor seeding is extremely low (less than 0.01%), and the risk of bleeding is very rare, with most cases being self‐limiting …”

“…5 With advancing biopsy techniques, the use of renal mass biopsy is recommended due to increased accuracy in interpretation (accurate diagnoses can be rendered in more than 90% of renal masses biopsied) and rare minor complications in less than 1% of cases. [6][7][8][9] The risk of tumor seeding is extremely low (less than 0.01%), and the risk of bleeding is very rare, with most cases being self-limiting. [8][9][10] Sampling via endoscopic ultrasound guided biopsy has also been attempted, 11,12 and some urologists have adopted the use of office based ultrasound guided renal biopsies in selected patients.…”