Diagnosis and Staging
Renal biopsy
This information has been reproduced with the permission of the EAU Guidelines Office.
Renal tumour biopsies are increasingly being used in diagnosis, in follow-up surveillance and in ablative therapies1- 6 (level of evidence: 3). In most series, a core biopsy demonstrates high specificity and high sensitivity for the presence of malignancy1-5, though it should be noted that 10-20% of biopsies are nonconclusive.
Biopsy aims to determine eventual malignancy, type, and grade of the evaluated renal mass. A percutaneous mass biopsy is rarely required for large renal masses scheduled for nephrectomy. The positive predictive value of imaging findings is so high that a negative biopsy result does not alter management6 (level of evidence: 3).
Biopsy is also indicated in metastatic patients before starting systemic therapy7 (level of evidence: 3).
References:
1. Brierly RD, Thomas PJ, Harrison NW, Fletcher MS, Nawrocki JD, Ashton-Key M. Evaluation of fine needle aspiration cytology for renal masses. BJU Int 2000;85(1):14-8. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/10619937
2.Dechet CB, Zincke H, Sebo TJ, King BF, LeRoy AJ, Farrow GM, Blute ML. Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 2003;169(1):71-4. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/12478106
3. Remzi M, Marberger M. Renal tumor biopsies for evaluation of small renal tumors: why, in whom and how? Eur Urol 2009 Feb;55: 359-67.
http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/18849108
4.Shannon BA, Cohen RJ, de Bruto H, Davies RJ. The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses. J Urol 2008 Oct;180(4):1257-61; discussion 1261. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/18707712
5.Volpe A, Mattar K, Finelli A, Kachura JR, Evans AJ, Geddie WR, Jewett MA. Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience. J Urol 2008 Dec;180(6):2333-7. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/18930274
6. Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 2006 Jul:240(1):6-22. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/16709793
7.Dutcher JP, de Souza P, McDermott D, Figlin RA, Berkenblit A, Thiele A, Krygowski M, Strahs A, Feingold J, Hudes G. Effect of temsirolimus versus interferon-alpha on outcome of patients with advanced renal cell carcinoma of different tumor histologies. Med Oncol 2009;26(2):202-9.
http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/19229667