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Natural History of Renal Oncocytoma diagnosed by percutaneous biopsy
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Natural History of Renal Oncocytoma diagnosed by percutaneous biopsy
Brian H. Eisner, MD, Anthony E. Samir, MD, Jairam R. Eswara, MD, Brian F. Chapin, MD, Claire Kauffman, BA, Debra A. Gervais, MD, Peter R. Mueller, MD, Francis J. McGovern, MD, W. S. McDougal, MD.
Massachusetts General Hospital, Boston, MA, USA.
Background: We analyzed the growth pattern of renal oncocytoma diagnosed by percutaneous biopsy and compared the renal function of patients treated conservatively with those treated by partial nephrectomy.
Methods: A retrospective review was performed to identify patients diagnosed with renal oncocytoma by percutaneous biopsy or partial nephrectomy. Group 1 consisted of patients diagnosed by percutaneous biopsy. Group 2 consisted of 14 patients who underwent partial nephrectomy (without preoperative biopsy) for solid renal lesions which were diagnosed as oncocytomas by analysis of the surgical specimen. 10 patients underwent combined core biopsy with FNA and 1 patient had core only. Core biopsy was performed using 15-18 gauge cutting needles and fine needle aspirations (FNAs) were performed with 20-23 gauge Chiba needles. None of the patients in Group 1 had surgery or ablative procedures during the study period. Yearly growth rate was estimated using serial computed tomography (CT). Comparison of post-procedure golmerular filtration rate using the MDRD equation (Modified Diet in Renal Disease) was made between the two groups.
Results: Eleven (11) biopsy-diagnosed oncocytomas were followed for a median of 1.5 years (range 1.0-4.9 years ). Mean axial diameter at time of biopsy was 3.3 cm (range 1.3-7.1cm). Mean growth rate was 0.2 cm per year (range 0-1cm). 2/11 lesions (18%) grew at a rate > 0.3cm/year. Comparative parameters between these 11 biopsied oncocytomas and 14 patients who underwent partial nephrectomy for oncocytoma are as follows: mean age 68.5 versus 71.4 (p=0.36), mean diameter 3cm versus 2.5 cm (p=0.26), mean follow-up (years) 1.2 vs 1.4 (p=0.12), mean change in GFR 4.1 vs 11 cc/min (p=0.11).
Conclusions: Oncocytomas are slow growing lesions, with a majority growing less than 0.3 cm per year. Though not statistically significant, analysis showed a trend towards better preservation of renal function in patients who were treated conservatively when compared with those who underwent partial nephrectomy for oncocytoma.
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