Semin intervent Radiol 2014; 31(01): 020-026
DOI: 10.1055/s-0033-1363839
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of Percutaneous Needle Biopsy for Renal Masses

Elaine M. Caoili
1   Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
,
Matthew S. Davenport
1   Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2014 (online)

Abstract

The role of percutaneous renal mass biopsy has expanded considerably in the past 10 years. The incidence of incidentally detected small (< 4 cm) solid renal masses is on the rise, and despite a commensurate increase in nephron-sparing treatment, the mortality rate from renal cell carcinoma remains the same. Earlier detection and treatment have not had dramatic effects on population outcome, implying that not all small renal masses will grow to be life-limiting. Indeed, many small solid renal masses are benign, and among those that are malignant, not all share the same malignant behavior. Percutaneous biopsy provides a minimally invasive method for discriminating benign from malignant renal masses, and portends the potential for stratifying malignant risk. With recent improvements in image-guided equipment and technique, percutaneous renal mass biopsy can be performed safely and effectively, with a low complication rate (< 5%) and a high diagnostic yield (> 90%).

 
  • References

  • 1 Herts BR, Baker ME. The current role of percutaneous biopsy in the evaluation of renal masses. Semin Urol Oncol 1995; 13 (4) 254-261
  • 2 Lane BR, Samplaski MK, Herts BR, Zhou M, Novick AC, Campbell SC. Renal mass biopsy—a renaissance?. J Urol 2008; 179 (1) 20-27
  • 3 Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 2006; 240 (1) 6-22
  • 4 Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology 2008; 249 (1) 16-31
  • 5 Tan HJ, Jacobs BL, Hafez KS , et al. Understanding the role of percutaneous biopsy in the management of patients with a small renal mass. Urology 2012; 79 (2) 372-377
  • 6 Halverson SJ, Kunju LP, Bhalla R , et al. Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol 2013; 189 (2) 441-446
  • 7 Volpe A, Cadeddu JA, Cestari A , et al. Contemporary management of small renal masses. Eur Urol 2011; 60 (3) 501-515
  • 8 Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006; 98 (18) 1331-1334
  • 9 Chow WH, Devesa SS, Warren JL, Fraumeni Jr JF. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281 (17) 1628-1631
  • 10 Cho E, Adami HO, Lindblad P. Epidemiology of renal cell cancer. Hematol Oncol Clin North Am 2011; 25 (4) 651-665
  • 11 Zagoria RJ. Imaging of small renal masses: a medical success story. AJR Am J Roentgenol 2000; 175 (4) 945-955
  • 12 Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003; 170 (6, Pt 1): 2217-2220
  • 13 Lane BR, Babineau D, Kattan MW , et al. A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol 2007; 178 (2) 429-434
  • 14 Patard JJ, Leray E, Rioux-Leclercq N , et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 2005; 23 (12) 2763-2771
  • 15 Ljungberg B, Cowan NC, Hanbury DC , et al; European Association of Urology Guideline Group. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58 (3) 398-406
  • 16 Van Poppel H, Joniau S. Is surveillance an option for the treatment of small renal masses?. Eur Urol 2007; 52 (5) 1323-1330
  • 17 Caoili EM, Bude RO, Higgins EJ, Hoff DL, Nghiem HV. Evaluation of sonographically guided percutaneous core biopsy of renal masses. AJR Am J Roentgenol 2002; 179 (2) 373-378
  • 18 Maturen KE, Nghiem HV, Caoili EM, Higgins EG, Wolf Jr JS, Wood Jr DP. Renal mass core biopsy: accuracy and impact on clinical management. AJR Am J Roentgenol 2007; 188 (2) 563-570
  • 19 Ralls PW, Barakos JA, Kaptein EM , et al. Renal biopsy-related hemorrhage: frequency and comparison of CT and sonography. J Comput Assist Tomogr 1987; 11 (6) 1031-1034
  • 20 Strope SA, Wolf Jr JS, Hafez KS , et al. Understanding the relationship between health care quality and the renal mass. Urol Oncol 2009; 27 (4) 443-447
  • 21 Kim JK, Park SY, Shon JH, Cho KS. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology 2004; 230 (3) 677-684
  • 22 Sasiwimonphan K, Takahashi N, Leibovich BC, Carter RE, Atwell TD, Kawashima A. Small (<4 cm) renal mass: differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging. Radiology 2012; 263 (1) 160-168
  • 23 Hindman N, Ngo L, Genega EM , et al. Angiomyolipoma with minimal fat: can it be differentiated from clear cell renal cell carcinoma by using standard MR techniques?. Radiology 2012; 265 (2) 468-477
  • 24 Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics 2008; 28 (1) 255-277 , quiz 327–328
  • 25 Dyer R, DiSantis DJ, McClennan BL. Simplified imaging approach for evaluation of the solid renal mass in adults. Radiology 2008; 247 (2) 331-343
  • 26 Choyke PL, Glenn GM, Walther MM, Zbar B, Linehan WM. Hereditary renal cancers. Radiology 2003; 226 (1) 33-46
  • 27 Verine J, Pluvinage A, Bousquet G , et al. Hereditary renal cancer syndromes: an update of a systematic review. Eur Urol 2010; 58 (5) 701-710
  • 28 Birnbaum BA, Maki DD, Chakraborty DP, Jacobs JE, Babb JS. Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom. Radiology 2002; 225 (1) 83-90
  • 29 Maki DD, Birnbaum BA, Chakraborty DP, Jacobs JE, Carvalho BM, Herman GT. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology 1999; 213 (2) 468-472
  • 30 Gerst S, Hann LE, Li D , et al. Evaluation of renal masses with contrast-enhanced ultrasound: initial experience. AJR Am J Roentgenol 2011; 197 (4) 897-906
  • 31 Israel GM, Bosniak MA. How I do it: evaluating renal masses. Radiology 2005; 236 (2) 441-450
  • 32 Bosniak MA, Megibow AJ, Hulnick DH, Horii S, Raghavendra BN. CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol 1988; 151 (3) 497-501
  • 33 Davenport MS, Neville AM, Ellis JH, Cohan RH, Chaudhry HS, Leder RA. Diagnosis of renal angiomyolipoma with Hounsfield unit thresholds: effect of size of region of interest and nephrographic phase imaging. Radiology 2011; 260 (1) 158-165
  • 34 Israel GM, Hindman N, Hecht E, Krinsky G. The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol 2005; 184 (6) 1868-1872
  • 35 Kawashima A, Sandler CM, Ernst RD, Tamm EP, Goldman SM, Fishman EK. CT evaluation of renovascular disease. Radiographics 2000; 20 (5) 1321-1340
  • 36 Browne RF, Riordan EO, Roberts JA , et al. Renal artery aneurysms: diagnosis and surveillance with 3D contrast-enhanced magnetic resonance angiography. Eur Radiol 2004; 14 (10) 1807-1812
  • 37 Shonai T, Koito K, Ichimura T, Hirokawa N, Sakata K, Hareyama M. Renal artery aneurysm: evaluation with color Doppler ultrasonography before and after percutaneous transarterial embolization. J Ultrasound Med 2000; 19 (4) 277-280
  • 38 Harisinghani MG, Maher MM, Gervais DA , et al. Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery?. AJR Am J Roentgenol 2003; 180 (3) 755-758
  • 39 Rybicki FJ, Shu KM, Cibas ES, Fielding JR, vanSonnenberg E, Silverman SG. Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol 2003; 180 (5) 1281-1287
  • 40 Hayakawa M, Hatano T, Tsuji A, Nakajima F, Ogawa Y. Patients with renal cysts associated with renal cell carcinoma and the clinical implications of cyst puncture: a study of 223 cases. Urology 1996; 47 (5) 643-646
  • 41 Bosniak MA. The Bosniak renal cyst classification: 25 years later. Radiology 2012; 262 (3) 781-785
  • 42 O'Malley RL, Godoy G, Hecht EM, Stifelman MD, Taneja SS. Bosniak category IIF designation and surgery for complex renal cysts. J Urol 2009; 182 (3) 1091-1095
  • 43 Appelbaum AH, Kamba TT, Cohen AS, Qaisi WG, Amirkhan RH. Effectiveness and safety of image-directed biopsies: coaxial technique versus conventional fine-needle aspiration. South Med J 2002; 95 (2) 212-217
  • 44 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) 14-18
  • 45 Helm CW, Burwood RJ, Harrison NW, Melcher DH. Aspiration cytology of solid renal tumours. Br J Urol 1983; 55 (3) 249-253
  • 46 Murphy WM, Zambroni BR, Emerson LD, Moinuddin S, Lee LH. Aspiration biopsy of the kidney. Simultaneous collection of cytologic and histologic specimens. Cancer 1985; 56 (1) 200-205
  • 47 Goethuys H, Van Poppel H, Oyen R, Baert L. The case against fine-needle aspiration cytology for small solid kidney tumors. Eur Urol 1996; 29 (3) 284-287
  • 48 Truong LD, Todd TD, Dhurandhar B, Ramzy I. Fine-needle aspiration of renal masses in adults: analysis of results and diagnostic problems in 108 cases. Diagn Cytopathol 1999; 20 (6) 339-349
  • 49 Juul N, Torp-Pedersen S, Grønvall S, Holm HH, Koch F, Larsen S. Ultrasonically guided fine needle aspiration biopsy of renal masses. J Urol 1985; 133 (4) 579-581
  • 50 Murphy WM, Zambroni BR, Emerson LD, Moinuddin S, Lee LH. Aspiration biopsy of the kidney. Simultaneous collection of cytologic and histologic specimens. Cancer 1985; 56 (1) 200-205
  • 51 Campbell SC, Novick AC, Herts B , et al. Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity. Urology 1997; 50 (1) 25-29
  • 52 Niceforo J, Coughlin BF. Diagnosis of renal cell carcinoma: value of fine-needle aspiration cytology in patients with metastases or contraindications to nephrectomy. AJR Am J Roentgenol 1993; 161 (6) 1303-1305
  • 53 Lechevallier E, André M, Barriol D , et al. Fine-needle percutaneous biopsy of renal masses with helical CT guidance. Radiology 2000; 216 (2) 506-510
  • 54 Volpe A, Kachura JR, Geddie WR , et al. Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 2007; 178 (2) 379-386
  • 55 Lane BR, Campbell SC, Aydun H , et al. The impact of number and location of cores on the diagnostic accuracy of renal mass biopsy: an ex vivo study. J Urol 2008; 179: 477-478
  • 56 Wood BJ, Khan MA, McGovern F, Harisinghani M, Hahn PF, Mueller PR. Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. J Urol 1999; 161 (5) 1470-1474
  • 57 Dechet CB, Sebo T, Farrow G, Blute ML, Engen DE, Zincke H. Prospective analysis of intraoperative frozen needle biopsy of solid renal masses in adults. J Urol 1999; 162 (4) 1282-1284 , discussion 1284–1285
  • 58 Ralls PW, Barakos JA, Kaptein EM , et al. Renal biopsy-related hemorrhage: frequency and comparison of CT and sonography. J Comput Assist Tomogr 1987; 11 (6) 1031-1034
  • 59 Slywotzky C, Maya M. Needle tract seeding of transitional cell carcinoma following fine-needle aspiration of a renal mass. Abdom Imaging 1994; 19 (2) 174-176
  • 60 Silberzweig JE, Tey S, Winston JA, Mitty HA. Percutaneous renal biopsy complicated by renal capsular artery pseudoaneurysm. Am J Kidney Dis 1998; 31 (3) 533-535
  • 61 Leveridge MJ, Finelli A, Kachura JR , et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 2011; 60 (3) 578-584
  • 62 Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C. Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 2004; 171 (5) 1802-1805