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Diagnostic accuracy and safety of percutaneous MRI-guided biopsy of solid renal masses: single-center results after 4.5 years

  • Interventional
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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To retrospectively evaluate diagnostic accuracy and complications of magnetic resonance imaging (MRI)-guided biopsy of radiologically indeterminate solid renal masses (RM).

Methods

Electronic records of all consecutive patients undergoing MRI-guided biopsy of solid RM (using free-breathing T2-BLADE and BEAT-IRTTT sequences) between April 2014 and October 2018 were reviewed; 101 patients (69 men, 32 women; median age 68 years; range 32–76) were included. Patient and RM characteristics, procedural details/complications, pathologic diagnosis, and clinical management were recorded. Diagnostic accuracy was calculated on an intention-to-diagnose basis. Diagnostic yield was also evaluated. Multi-variable analysis was performed for variables with p < .20, including patient age/sex; RM size/location/contact with vascular pedicle, RENAL score, number and total length of biopsy samples, and biopsy tract embolization, to determine factors associated with diagnostic samples, diagnostic accuracy, and complications.

Results

Median RM size was 2.4 cm (range 1–8.4 cm). There were 86 (85%; 95%CI 77–91%) diagnostic and 15 (15%; 95%CI 9–23%) non-diagnostic samples; 6/15 (40%) non-diagnostic biopsies were repeated with 50% malignancy rate. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 96% (95%CI 89–99%), 100% (95%CI 77–100%), 100% (95%CI 95–100%), 82% (95%CI 57–96%), and 97% (95%CI 90–99%), respectively. Primary and secondary diagnostic yields were 85% (95%CI 77–91%) and 91% (95%CI 84–96%), respectively. Seven (7%; 95%CI 1–10%) complications were observed. No tested variables were associated with diagnostic samples, diagnostic accuracy, or complications.

Conclusions

MRI-guided biopsy of solid RM is associated with high diagnostic accuracy and low complication rate. The technique might be helpful for inaccessible tumors.

Key Points

• MRI-guided biopsy of radiologically indeterminate solid renal masses (RM) appears safe, with a low rate of minor self-limiting hemorrhagic complications.

• Diagnostic accuracy and primary/secondary diagnostic yield are high and appear similar to reported estimates for US- and CT-guided RM biopsy.

• MRI guidance may be particularly useful for RM with poor conspicuity on US and CT, for relatively inaccessible tumors (e.g., tumors requiring double-oblique steep-angled approaches), and for young patients or those with renal failure.

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Abbreviations

FN:

False Negative

FP:

False Positive

ISUP:

International Society of Urologic Pathologists

NPV :

Negative Predictive Value

PPV:

Positive Predictive Value

RCC:

Renal Cell Carcinoma

RM:

Renal Masses

TN:

True Negative

TP:

True Positive

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Interventional Radiology, University Hospital of Strasbourg, 1, place de l’hôpital, 67000, Strasbourg, France

    Roberto Luigi Cazzato, Pierre De Marini, Pierre Auloge, Loic Leclerc, Julien Garnon & Afshin Gangi

  2. Department of Urology, University Hospital of Strasbourg, 1, place de l’hôpital, 67000, Strasbourg, France

    Thibault Tricard & Hervé Lang

  3. Department of Pathology, University Hospital of Strasbourg, 1, place de l’hôpital, 67000, Strasbourg, France

    Veronique Linder & Marion Jost

  4. Department of Radiology, Norfolk and Norwich University Hospital, Colney Ln, Norwich, NR4 7UY, UK

    Nitin Ramamurthy

Authors
  1. Roberto Luigi Cazzato
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  2. Pierre De Marini
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  10. Julien Garnon
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Correspondence to Roberto Luigi Cazzato.

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The scientific guarantor of this publication is Afshin Gangi.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Electronic supplementary material

ESM 1

Supplementary Figure. Receiver Operating Characteristic analysis for Renal Mass Size and Total Length of Biopsy Sample demonstrating assessment of optimal cut-off values for obtaining diagnostic samples. (DOCX 229 kb)

ESM 2

Video. Multiplanar real-time free-breathing MR-fluoroscopy sequence obtained during MRI-guided biopsy of a 15 mm endophytic right renal nodule in a 73-year-old man. The biopsy sample revealed a clear cell renal cell carcinoma. (MP4 14,642 kb)

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Cazzato, R.L., De Marini, P., Auloge, P. et al. Diagnostic accuracy and safety of percutaneous MRI-guided biopsy of solid renal masses: single-center results after 4.5 years. Eur Radiol 31, 580–590 (2021). https://doi.org/10.1007/s00330-020-07160-6

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  • DOI: https://doi.org/10.1007/s00330-020-07160-6

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