Indications for Kidney Fine Needle Aspiration (FNA) in the Era of Modern Renal Imaging Modalities.
Lina Liu, Ema Dragoescu. Virginia Commonwealth University Health System, Richmond
Background: Modern renal imaging modalities, particularly dedicated (thin-slice) renal CT scan with contrast and gadolinium-enhanced MRI, allow detailed evaluation of renal lesions, and the decision to follow-up or perform nephrectomy is often based on radiological studies alone without pathologic confirmation. Consequently, kidney FNA has become an uncommon procedure in our institution. The purpose of this study is to investigate the current indications for kidney FNA, assess its diagnostic utility, and evaluate cytologic/histologic correlation.
Design: All cases of kidney FNA performed in our center between January 2005 and August 2010 were retrieved. Clinical information, past medical history, radiologic findings, cytologic and subsequent histologic diagnoses, if available, were recorded.
Results: 41 cases (from 38 patients) of kidney FNA were identified: 23 (56%) were ultrasound-guided and 18 (44%) CT-guided. Indications for performing kidney FNA are summarized in table 1. The inconclusive solid masses were renal tumors with abnormal vascular pattern suggesting other entities in the differential diagnosis (oncocytoma, angiomyolipoma with minimal fat, urothelial carcinoma, or adrenal neoplasms).
|Indications||Total number of cases|
|CT-scan favors renal cell carcinoma (RCC), but patient has prior history of other malignancy, extensive metastatic disease, or extensive local disease||17(41.46%)|
|Solid renal masses inconclusive on renal imaging||12(29.27%)|
|Kidney masses on dialysis patients||3(7.32%)|
|Other (CT-scan favors lymphoma or urothelial carcinoma-1 case each)||2(4.88%)|