Keywords:
Cancer, Efficacy studies, Biopsy, Ultrasound, Oncology, Kidney
Authors:
D. Plut, S. Ponorac, D. Vidmar-Bracika; Ljubljana/SI
DOI:
10.1594/ecr2013/C-1742
Purpose
Percutaneous ultrasound-guided biopsy of renal masses is a safe and accurate procedure,
once reserved for the diagnosis of unresectable renal cell carcinoma,
metastases,
lymphoma,
and infection (1-3).
Today percutaneous ultrasound-guided biopsy has an expanded role.
A substantial proportion of small,
solid renal masses are benign neoplasms.
Although imaging can be used to diagnose most of them,
some are incorrectly believed to represent renal cell carcinomas and result in unnecessary surgeries.
Percutaneous biopsy can now be used to diagnose these benign neoplasms and thus prevent them from being treated unnecessarily (1).
Results from percutaneous biopsy can provide added value by directly affecting therapy choices for patients with presumed malignant lesions who may not be candidates for resection and also in patients for whom partial nephrectomy rather than radical nephrectomy may be a preferred alternative treatment (4).
Fig. 1: Uncharacterized small solid renal lesion suitable for characterization with fine-needle aspiration cytology.
Biopsy using fine needles (fine-needle aspiration biopsy - FNAB,
FNA or NAB,
or fine-needle aspiration cytology - FNAC),
using 20 gauge or thinner needles,
has been shown to be accurate in the diagnosis of renal masses.
This is largely due to enhancements in cytologic techniques (immunocytochemistry and cytogenetics) that have allowed for the accurate diagnosis of benign and malignant neoplasms and in some cases the determination of renal cell carcinoma subtype and Fuhrman nuclear grade.
Given the lack of conclusive evidence that large needles confer a greater diagnostic effectiveness,
fine-needle specimens are initially obtained and if the specimens are not adequate,
a large needle biopsy is then performed (1).
In recent years,
urologists at the Clinical Centre of Ljubljana have begun skipping fine-needle aspiration biopsy of solid renal lesions in favour of large-needle biopsy or direct surgical procedures.
The purpose of our study was to evaluate the performance of fine-needle aspiration cytology and to determine its place in diagnostic procedures of solid renal lesions.