The Value of Preoperative Needle Core Biopsy for Diagnosing Benign Lesions Among Small, Incidentally Detected Renal Masses

Shannon, Beverley A.; Cohen, Ronald J.; Bruto, Hildemarie de; Davies, Robert J.

doi:10.1016/j.juro.2008.06.030

Cited by 166 publications

(121 citation statements)

References 18 publications

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“…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.…”

Section: Resultsmentioning

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%

“…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%

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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“…Another option is to employ preoperative needle core biopsy for select lesions, which has been shown to be an accurate method for pathological diagnosis. 21 Based on the findings from this study where peripheral renal lesions carry a significant probability of having benign pathology, we suggest that preoperative biopsy of these lesions may be warranted. …”

Section: Discussionmentioning

confidence: 75%

Tumour location as a predictor of benign disease in the management of renal masses

Mason¹,

Abdolell²,

Rendon³

2013

CUAJ

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Objective: To investigate the association between tumour location and the proportion of benign disease in renal masses presumed to be renal cell carcinoma (RCC) preoperatively. Methods: This Institutional Review Board approved study includes 196 patients who underwent surgical treatment for renal masses <5 cm at our institution by a single surgeon between January 2002 and June 2009. Based on preoperative imaging, each mass was designated as central (touching or encroaching upon the renal collecting system and/or renal sinus) or peripheral. The association between tumour location and benign pathology was determined using univariate and multiple logistic regression, including tumour size and patient sex in the model. Results: The proportion of histologically confirmed benign disease in this series was 11.2%. The proportion of benign disease by location was 5.9% and 19.5% for central and peripheral masses, respectively. The effect of location was found to have a significant prognostic value (p = 0.0273) with an adjusted odds ratio of 3.51 (95% CI = 1.38-19.62) for the odds of a benign diagnosis in peripheral compared to central tumours. Tumour size and patient sex were not significant predictors of benign pathology (p = 0.483 and 0.191, respectively). Conclusions: Peripherally located renal masses are more likely to be benign than centrally located renal masses. This information may be used when selecting strategies for the management of renal masses presumed to be RCC.

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“…Although few cases have been reported in the literature, 5,12 no cases of seeding have been reported when a coaxial technique is used. 2,[13][14][15][16][17][18][19][20][21] Complication rate of the procedure is low, at around 1%. Bleeding represents the most frequent complication, which usually results in a subcapsular or perinephric haematoma requiring no interventional treatment.…”

Section: Renal Biopsy Techniquementioning

confidence: 99%

The role of renal biopsy in small renal masses

Burruni

Lhermitte

Cerantola

et al. 2016

CUAJ

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Renal biopsy is being increasingly proposed as a diagnostic tool to characterize small renal masses (SRM). Indeed, the wide adoption of imaging in the diagnostic workup of many diseases had led to a substantial increased incidence of SRM (diameter ≤4 cm). While modern ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) techniques have high sensitivity for detecting SRM, none is able to accurately and reliably characterize them in terms of histological features. This is currently of key importance in guiding clinical decision-making in some situations, and in these cases renal biopsy should be considered.In this review, we aim to summarize the technique, diagnostic performance, and predicting factors of nondiagnostic biopsy, as well as the future perspectives.

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The Value of Preoperative Needle Core Biopsy for Diagnosing Benign Lesions Among Small, Incidentally Detected Renal Masses

Cited by 166 publications

References 18 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

Tumour location as a predictor of benign disease in the management of renal masses

The role of renal biopsy in small renal masses

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