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Should small solid renal masses be biopsied prior to recommending therapy?
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Should small solid renal masses be biopsied prior to recommending therapy?
Brian Kowal, MD, Andrew Forauer, MD, John Gemery, MD, William Bihrle, MD, John D. Seigne, MB.
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Background:
There is considerable controversy about the role of biopsy in the management of the solid renal mass. For the past 16 months we have recommended that patients presenting with a small solid renal mass undergo a percutaneous biopsy prior to definitive treatment. We performed a retrospective review to evaluate #1: the ability of the biopsy to make a diagnosis, #2: complication rate, #3 the frequency of benign conditions and #4 how often the biopsy result changed management.
Methods:
In November of 2006 all patients presenting with a solid renal mass < 4cm in size were recommended to have a renal biopsy prior to treatment. 65 patients accepted the recommendation and underwent a CT guided percutaneous aspirate and core biopsy. The clinical, radiological and pathological records of these patients were retrospectively reviewed.
Results:
65 patients underwent outpatient percutaneous biopsy. A definitive diagnosis was established in 59 patients (91%). Of the 65 solid renal masses 17 (26%) were benign including 9 Oncocytomas, 4 lipid poor angiomyolipomas, 2 abcesses, 1 leiomyoma and 1 metanephric adenoma. | Size of mass | Number of masses | Number Benign | Number Indeterminate Bx | | 0-1.99cm | 11 | 5 | 3 * | | 2.0 -2.99cm | 28 | 6 | 2 | | 3.00-4.00cm | 26 | 6 | 1 |
* P=0.05 Fisher
14 (21%) patients had minor complications including 12 small perinephric hematomas (none required transfusion or delayed same day discharge), 1 difficulty voiding and 1 shoulder pain. The biopsy clearly changed management in the 17 benign lesions. Of the remaining 48 patients only 16 underwent partial nephrectomy with the remainder electing needle ablation or observation. Thus the biopsy provided diagnostic information in 43/65 (66%) of the masses.
Conclusions:
CT guided biopsy of a small solid renal mass is a safe procedure that provides diagnostic information >90% of the time. Biopsy provides clinically useful information by identification of benign lesions and confirmation of type and grade of malignancy if either observation or needle ablative therapy are a consideration.
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