Renal Percutaneous Needle Core Biopsy Verse Fine Needle Aspiration, or Both?
Chengbao Liu, Alan Heimann, Wayne Waltzer, Jingxuan Liu. Stony Brook University Medical Center, Stony Brook, NY
Background: Renal mass biopsies are often used to establish a definitive diagnosis before making treatment decisions. The use of biopsies to guide clinical management has the potential benefit of reducing unnecessary treatment since a substantial percentage of lesions are non-neoplastic. However, previously reported relatively high false-negative rate in renal mass biopsies has made the diagnostic use of renal mass biopsy controversial. There are two types of percutaneous kidney biopsies: needle core biopsy and fine needle aspiration (FNA). Our study aims to compare the sensitivity of these two types of biopsies in order to determine whether it is beneficial to conduct both biopsies on renal masses.
Design: Retrospective data were collected from patients with renal mass lesions who underwent percutaneous needle core biopsy and / or fine needle aspiration (FNA) from 2000 to 2012 at an academic center. Patients with known polycystic kidney disease or transplant were excluded. The histologic and cytologic findings of the biopsies were analyzed to compare the sensitivity of the two methods.
Results: A total of 80 patient records met the search criteria. Of these, 65 were percutaneous needle core biopsy and 50 were FNA. Thirty five patients underwent both procedures. Of the 65 cases of percutaneous needle core biopsy, 41 (63.1%) had a definitive tumor diagnosis (including: renal cell carcinoma of clear cell type and papillary type, oncocytoma, diffuse large B cell lymphoma, sarcoma, urothelial carcinoma, angiomyolipoma, adenocarcinoma), 21 (32.3%) had non-tumorous findings, and 3 (4.6%) were non-diagnostic. Of the 50 cases of FNA, 33 (66%) were found to have a definitive tumor diagnosis, 5 (10%) were non-tumorous, and 12 (24%) cases were non-diagnostic. Of the 35 patients underwent both procedures, 28 (80%) cases had a definitive tumor diagnosis with at least one test positive, compared to 24 (68.6%) and 26 (74.3%) for percutaneous needle core biopsy and FNA, respectively. When the diagnoses were made by combining both procedures, the rate of non-diagnostic results dropped to 0.
Conclusions: While percutaneous core biopsy and FNA have similar rate for detection of renal lesions, the non-diagnostic rate is lower for needle core biopsy than for FNA. Combining results from both procedures decrease the false negative rate and the rate of non-diagnostic cases. Therefore, the practice of conducting both types of renal mass biopsies may be considered for making more accurate diagnosis.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 1:00 PM
Poster Session II # 168, Monday Afternoon