The contemporary role of renal mass biopsy in the management of small renal tumors

Abstract

The selective use of percutaneous biopsy for diagnosis in renal masses is a relatively uncommon approach when compared to the management of other solid neoplasms. With recent advancements in imaging techniques and their widespread use, the incidental discovery of asymptomatic, small renal masses (SRM) is on the rise and a substantial percentage of these SRM are benign. Recent advances in diagnostics have significantly improved accuracy rates of renal mass biopsy (RMB), making it a potentially powerful tool in the management of SRM. In this review, we will discuss the current management of SRM, problems with the traditional view of RMB, improvements in the diagnostic power of RMB, cost-effectiveness of RMB, and risks associated with RMB. RMB may offer important information enabling treating clinicians to better risk-stratify patients and ultimately provide a more personalized treatment approach for SRM.

Keywords: nephrectomy; renal biopsy; renal cell carcinoma; renal mass; renal neoplasms.

Figure 1

(A) A single axial CT image from a percutaneous CT guided biopsy using a coaxial technique and a 22-guage needle for fine needle aspirate sampling in a female with an incidentally detected 2.7 cm lower pole R renal mass. Pathology reported renal cell carcinoma, without subtyping. (B) An ultrasound image with the needle guide in place of a male with an incidentally detected 3.5 cm right upper pole renal mass. (C) A second ultrasound image from a percutaneous US guided biopsy using a coaxial technique and an 18-guage needle for core biopsy. Pathology reported as renal cell carcinoma, conventional clear cell type, Furman grade I–II.