Advertisement

Should Renal Mass Biopsy Be Performed prior to or Concomitantly with Thermal Ablation?

Published:August 01, 2018DOI:https://doi.org/10.1016/j.jvir.2018.04.028

      Abstract

      Purpose

      To determine diagnostic yield of renal biopsies performed in patients referred for image-guided tumor ablation (IGTA) and the frequency with which biopsy results would have obviated the need for subsequent ablation.

      Materials and Methods

      Retrospective review of an internal ablation database of a single institution revealed 401 consecutive percutaneous renal mass IGTAs performed from April 2000 to April 2015. Of 401 ablations, 32 were excluded, yielding 369 ablation events in 342 patients, which represented the study cohort. Patients were subdivided into groups according to whether or not biopsy was performed. Lesions were categorized according to size, malignancy/benignity, and pathology.

      Results

      IGTA was performed with biopsy for 317/369 (85.9%) and without biopsy for 52/369 (14.1%) lesions. Overall diagnostic yield for percutaneous biopsy was 94.3% (299/317). Based on biopsy results, 82.6% (262/317) were classified as malignant or suspicious, 9.5% (30/317) were classified as likely benign, and 2.2% (7/317) were classified as definitively benign. Only definitively benign lesions were designated as obviating the need for IGTA. IGTA was supported by biopsy results in the remaining 97.8% (310/317), including renal cell carcinomas, oncocytic neoplasms, metastases, and nondiagnostic biopsy results.

      Conclusions

      Biopsy of renal masses with suspicious imaging features rarely (2.2%) obviated the need for IGTA. For patients who have undergone counseling and have elected to forgo active surveillance and surgical options, biopsy can safely be performed concomitantly with ablation.

      Abbreviations:

      CI (confidence interval), IGTA (image-guided thermal ablation), RCC (renal cell carcinoma)
      To read this article in full you will need to make a payment
      SIR Member Login
      Society Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Escudier B.
        • Porta C.
        • Schmidinger M.
        • et al.
        Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2016; 27: v58-v68
        • Umbreit E.C.
        • Shimko M.S.
        • Childs M.A.
        • et al.
        Metastatic potential of a renal mass according to original tumour size at presentation.
        BJU Int. 2012; 109 (discussion 194): 190-194
        • Krokidis M.E.
        • Orsi F.
        • Katsanos K.
        • Helmberger T.
        • Adam A.
        CIRSE guidelines on percutaneous ablation of small renal cell carcinoma.
        Cardiovasc Intervent Radiol. 2017; 40: 177-191
        • Frank I.
        • Blute M.L.
        • Cheville J.C.
        • Lohse C.M.
        • Weaver A.L.
        • Zincke H.
        Solid renal tumors: an analysis of pathological features related to tumor size.
        J Urol. 2003; 170: 2217-2220
        • Finelli A.
        • Ismaila N.
        • Bro B.
        • et al.
        Management of small renal masses: American Society of Clinical Oncology clinical practice guideline.
        J Clin Oncol. 2017; 35: 668-680
        • Campbell S.
        • Uzzo R.G.
        • Allaf M.E.
        • et al.
        Renal mass and localized renal cancer: AUA guideline.
        J Urol. 2017; 198: 520-529
        • Ljungberg B.
        • Albiges L.
        • Bensalah K.
        • et al.
        EAU guidelines on renal cell carcinoma. 2017 [updated March 2017].
        (Available at:) (Accessed March 17, 2018)
        • Khalilzadeh O.
        • Baerlocher M.O.
        • Shyn P.B.
        • et al.
        Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee.
        J Vasc Interv Radiol. 2017; 28: 1432-1437.e3
        • Blute Jr., M.L.
        • Drewry A.
        • Abel E.J.
        Percutaneous biopsy for risk stratification of renal masses.
        Ther Adv Urol. 2015; 7: 265-274
        • Maturen K.E.
        • Nghiem H.V.
        • Caoili E.M.
        • Higgins E.G.
        • Wolf Jr., J.S.
        • Wood Jr., D.P.
        Renal mass core biopsy: accuracy and impact on clinical management.
        AJR Am J Roentgenol. 2007; 188: 563-570
        • Volpe A.
        • Mattar K.
        • Finelli A.
        • et al.
        Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience.
        J Urol. 2008; 180: 2333-2337
        • Prince J.
        • Bultman E.
        • Hinshaw L.
        • et al.
        Patient and tumor characteristics can predict nondiagnostic renal mass biopsy findings.
        J Urol. 2015; 193: 1899-1904
        • Leveridge M.J.
        • Finelli A.
        • Kachura J.R.
        • et al.
        Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy.
        Eur Urol. 2011; 60: 578-584
        • Lebret T.
        • Poulain J.E.
        • Molinie V.
        • et al.
        Percutaneous core biopsy for renal masses: indications, accuracy and results.
        J Urol. 2007; 178 (discussion 1188): 1184-1188
        • Shannon B.A.
        • Cohen R.J.
        • de Bruto H.
        • Davies R.J.
        The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses.
        J Urol. 2008; 180 (discussion 1261): 1257-1261
        • Vasudevan A.
        • Davies R.J.
        • Shannon B.A.
        • Cohen R.J.
        Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy.
        BJU Int. 2006; 97: 946-949
        • Wang R.
        • Wolf Jr., J.S.
        • Wood Jr., D.P.
        • Higgins E.J.
        • Hafez K.S.
        Accuracy of percutaneous core biopsy in management of small renal masses.
        Urology. 2009; 73 (discussion 590–591): 586-590
        • Yang C.S.
        • Choi E.
        • Idrees M.T.
        • Chen S.
        • Wu H.H.
        Percutaneous biopsy of the renal mass: FNA or core needle biopsy?.
        Cancer Cytopathol. 2017; 125: 407-415
        • Evans A.J.
        • Delahunt B.
        • Srigley J.R.
        Issues and challenges associated with classifying neoplasms in percutaneous needle biopsies of incidentally found small renal masses.
        Semin Diagn Pathol. 2015; 32: 184-195
        • Patel H.D.
        • Druskin S.C.
        • Rowe S.P.
        • Pierorazio P.M.
        • Gorin M.A.
        • Allaf M.E.
        Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta-analysis.
        BJU Int. 2017; 119: 661-666
        • Fujii Y.
        • Komai Y.
        • Saito K.
        • et al.
        Incidence of benign pathologic lesions at partial nephrectomy for presumed RCC renal masses: Japanese dual-center experience with 176 consecutive patients.
        Urology. 2008; 72: 598-602
        • McKiernan J.
        • Yossepowitch O.
        • Kattan M.W.
        • et al.
        Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome.
        Urology. 2002; 60: 1003-1009
        • Gill I.S.
        • Matin S.F.
        • Desai M.M.
        • et al.
        Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients.
        J Urol. 2003; 170: 64-68
        • Kural A.R.
        • Demirkesen O.
        • Onal B.
        • et al.
        Outcome of nephron-sparing surgery: elective versus imperative indications.
        Urol Int. 2003; 71: 190-196
        • Jeon H.G.
        • Lee S.R.
        • Kim K.H.
        • et al.
        Benign lesions after partial nephrectomy for presumed renal cell carcinoma in masses 4 cm or less: prevalence and predictors in Korean patients.
        Urology. 2010; 76: 574-579
        • Tuncali K.
        • vanSonnenberg E.
        • Shankar S.
        • Mortele K.J.
        • Cibas E.S.
        • Silverman S.G.
        Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis.
        AJR Am J Roentgenol. 2004; 183: 575-582
        • Heilbrun M.E.
        • Zagoria R.J.
        • Garvin A.J.
        • et al.
        CT-guided biopsy for the diagnosis of renal tumors before treatment with percutaneous ablation.
        AJR Am J Roentgenol. 2007; 188: 1500-1505
        • Lay A.H.
        • Faddegon S.
        • Olweny E.O.
        • et al.
        Oncologic efficacy of radio frequency ablation for small renal masses: clear cell vs papillary subtype.
        J Urol. 2015; 194: 653-657
        • Gahan J.C.
        • Richter M.D.
        • Seideman C.A.
        • et al.
        The performance of a modified RENAL nephrometry score in predicting renal mass radiofrequency ablation success.
        Urology. 2015; 85: 125-129
        • Maxwell A.W.P.
        • Baird G.L.
        • Iannuccilli J.D.
        • Mayo-Smith W.W.
        • Dupuy D.E.
        Renal cell carcinoma: comparison of RENAL nephrometry and PADUA scores with maximum tumor diameter for prediction of local recurrence after thermal ablation.
        Radiology. 2017; 283: 590-597