Relative Utilization of Interventional Radiology Guided Fine Needle Aspiration Biopsy and Core Needle Biopsy for the Investigation of Renal Masses.
Jasreman Dhillon, Marilyn Dawlett, Sanjay Gupta, Kamran Ahrar, Michael Wallace, Ashutosh Lodhi, Savitri Krishnamurthy. MD Anderson Cancer Center, Houston, TX
Background: Renal masses can be sampled either by fine needle aspiration (FNA) or by thin core needle biopsy (CNB). In a state of the art institution where interventional radiology and pathology support is available including immediate assessment, we undertook this study to evaluate the relative utilization and efficacy of both these techniques in the preoperative investigation of renal masses.
Design: We searched our pathology files from January 2009 to December 2009 for patients with renal masses who were subjected to FNA and CNB, only FNA or CNB. Pathological parameters reviewed: size of the lesion, diagnosis on FNA/CNB and any ancillary techniques performed on both the types of specimens. Findings were correlated with surgical resection or clinical follow up. The relative sensitivities of FNA and CNB were compared by McNemar's test.
Results: We studied 179 patients; 145 underwent FNA and CNB, 20 FNA and 14 CNB alone. In the former group, a definite diagnosis was rendered on FNA in116 (80 %) patients in comparison to 134 (92 %) on CNB. While FNA alone was diagnostic of malignancy in 6/145 (4%) patients, CNB alone was positive in 22/145 (!5%) of the patients. The results of FNA alone performed in 20 patients yielded concordant result in all patients (100%) (16 malignant and 4 benign cysts,); CNB alone performed in 14 patients yielded concordant results in 13/14 (93 %) patients. Ancillary immunohistochemical studies were performed predominantly on CNB specimens in comparison to FNA (50 % vs 10 %).
Overall definite diagnosis was rendered on 127/156(81%) patients by FNA and in 134/148 (91%) patients by CNB. The sensitivity of CNB was significantly better than FNA using surgical resection and/or clinical follow up as the gold standard, (p=0.0137),
Conclusions: 1.FNA was utilized more often than CNB for the initial investigation of renal masses 2. We found CNB to be significantly better than FNA for the investigation of renal masses. 3. Although both techniques can be utilized for rendering a definite diagnosis, it is prudent to procure tissue using both modalities if possible due to the chances of discordant results using either technique alone.4. While both CNB and FNA can yield definite results based on conventional morphological examination, CNB was preferred over FNA in cases requiring ancillary studies for rendering a definite diagnosis.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 82, Wednesday Afternoon