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Stellenwert der CT-gesteuerten perkutanen Biopsie kleiner Tumoren in der Diagnostik des Nierenzellkarzinoms: aktueller Stand

Accuracy of CT-guided percutaneous biopsy of small masses in the diagnosis of renal cell carcinoma: status quo

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Zusammenfassung

Der kleine, inzidentell entdeckte Nierentumor stellt ein häufiges Problem in der klinischen Routinediagnostik dar. Zwar werden kleine Nierentumoren durch die leistungsfähigen, modernen Schnittbildverfahren immer häufiger entdeckt, die eindeutige Zuordnung der Dignität dieser Läsionen ist anhand der Bildgebung jedoch nicht immer zu gewährleisten. In der Hoffnung, eine minimal-invasive, histologische Klärung zu erzielen und die Zahl unnötiger operativer Eingriffe zu minimieren, wird der Ruf nach der perkutanen Biopsie kleiner Nierentumoren in den letzten Jahren zunehmend lauter. Der vorliegende Beitrag erläutert den aktuellen Stellenwert der perkutanen Biopsie kleiner Nierenraumforderungen unter besonderer Berücksichtigung der Entwicklung neuer histopathologischer Analyseverfahren, technischer Aspekte der Stanzbiopsie und der Zuverlässigkeit der Diagnosefindung. Darüber hinaus werden die Indikationen zur Stanzbiopsie kleiner Nierentumoren vor dem Hintergrund der aktuellen Literatur erörtert.

Abstract

The small, incidentally detected renal mass represents a common problem in clinical routine imaging. Indeed, small renal tumours are frequently detected by effective, modern cross-sectional imagers, whereas the differentiation of benign and malignant lesions still cannot be invariably assured by imaging solely. Aiming at a minimally invasive, histological analysis and minimizing the number of preventable operations, the desire for percutaneous biopsy of small renal masses has grown over the last few years. This report illustrates the accuracy of percutaneous renal mass biopsy with special regard to recent development of new histopathological methods of analysis, technical aspects of core biopsy and the reliability of determining diagnosis. Furthermore, indications for the biopsy of small renal masses are discussed against the background of the current literature.

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Literatur

  1. Beland MD, Mayo-Smith WW, Dupuy DE et al. (2007) Diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses: should we biopsy all that are indeterminate? AJR Am J Roentgenol 188: 792–797

    Article  PubMed  Google Scholar 

  2. Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158: 1–10

    PubMed  CAS  Google Scholar 

  3. Bosniak MA (2003) Should we biopsy complex cystic renal masses (Bosniak category III)? AJR Am J Roentgenol 181: 1425–1426; author reply 1426

    PubMed  Google Scholar 

  4. Campbell SC, Novick AC, Herts B et al. (1997) Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity. Urology 50: 25–29

    Article  PubMed  CAS  Google Scholar 

  5. Caoili EM, Bude RO, Higgins EJ et al. (2002) Evaluation of sonographically guided percutaneous core biopsy of renal masses. AJR Am J Roentgenol 179: 373–378

    PubMed  Google Scholar 

  6. Dechet CB, Bostwick DG, Blute Ml et al. (1999) Renal oncocytoma: multifocality, bilateralism, metachronous tumor development and coexistent renal cell carcinoma. J Urol 162: 40–42

    Article  PubMed  CAS  Google Scholar 

  7. Dechet CB, Zincke H, Sebo TJ et al. (2003) Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 169: 71–74

    Article  PubMed  Google Scholar 

  8. Ellis L, Curley S, Tanabe K (2004) Radiofrequency ablation for cancer. Springer, Berlin Heidelberg New York

  9. Frank I, Blute Ml, Cheville JC et al. (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170: 2217–2220

    Article  PubMed  Google Scholar 

  10. Goethuys H, Van Poppel H, Oyen R et al. (1996) The case against fine-needle aspiration cytology for small solid kidney tumors. Eur Urol 29: 284–287

    PubMed  CAS  Google Scholar 

  11. Heilbrun ME, Zagoria RJ, Garvin AJ et al. (2007) CT-guided biopsy for the diagnosis of renal tumors before treatment with percutaneous ablation. AJR Am J Roentgenol 188: 1500–1505

    Article  PubMed  Google Scholar 

  12. Herts BR (2003) Imaging for renal tumors. Curr Opin Urol 13: 181–186

    Article  PubMed  Google Scholar 

  13. Huo L, Sugimura J, Tretiakova MS et al. (2005) C-kit expression in renal oncocytomas and chromophobe renal cell carcinomas. Hum Pathol 36: 262–268

    Article  PubMed  CAS  Google Scholar 

  14. Jaff A, Molinie V, Mellot F et al. (2005) Evaluation of imaging-guided fine-needle percutaneous biopsy of renal masses. Eur Radiol 15: 1721–1726

    Article  PubMed  Google Scholar 

  15. Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51: 203–205

    Article  PubMed  CAS  Google Scholar 

  16. Jinzaki M, Tanimoto A, Narimatsu Y et al. (1997) Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology 205: 497–502

    PubMed  CAS  Google Scholar 

  17. Kuroda N, Toi M, Yamamoto M et al. (2004) Immunohistochemical identification of intracytoplasmic lumens by cytokeratin typing may differentiate renal oncocytomas from chromophobe renal cell carcinomas. Histol Histopathol 19: 23–28

    PubMed  CAS  Google Scholar 

  18. Lang EK, Macchia RJ, Gayle B et al. (2002) CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol 12: 2518–2524

    PubMed  Google Scholar 

  19. Lawrentschuk N, Davis ID, Bolton DM et al. (2006) Positron emission tomography (PET), immuno-PET and radioimmunotherapy in renal cell carcinoma: a developing diagnostic and therapeutic relationship. BJU Int 97: 916–922

    Article  PubMed  CAS  Google Scholar 

  20. Lechevallier E, Andre M, Barriol D et al. (2000) Fine-needle percutaneous biopsy of renal masses with helical CT guidance. Radiology 216: 506–510

    PubMed  CAS  Google Scholar 

  21. Maturen KE, Nghiem HV, Caoili EM et al. (2007) Renal mass core biopsy: accuracy and impact on clinical management. AJR Am J Roentgenol 188: 563–570

    Article  PubMed  Google Scholar 

  22. Neuzillet Y, Lechevallier E, Andre M et al. (2004) Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 171: 1802–1805

    Article  PubMed  Google Scholar 

  23. Remzi M, Katzenbeisser D, Waldert M et al. (2007) Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 99: 1002–1006

    Article  PubMed  Google Scholar 

  24. Richter F, Kasabian NG, Irwin RJ jr et al. (2000) Accuracy of diagnosis by guided biopsy of renal mass lesions classified indeterminate by imaging studies. Urology 55: 348–352

    Article  PubMed  CAS  Google Scholar 

  25. Rybicki FJ, Shu KM, Cibas ES et al. (2003) Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol 180: 1281–1287

    PubMed  Google Scholar 

  26. Schmidbauer J, Remzi M, Memarsadeghi M et al. (2008) Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol 53: 1003–1011

    Article  PubMed  Google Scholar 

  27. Somani BK, Nabi G, Thorpe P et al. (2007) Image-guided biopsy-diagnosed renal cell carcinoma: critical appraisal of technique and long-term follow-up. Eur Urol 51: 1289–1295 discussion 1296–1287

    Article  PubMed  Google Scholar 

  28. Tacke J, Mahnken AH (2004) Perkutane Radiofrequenzablation von Nierentumoren. Radiologe 44: 358–363

    Article  PubMed  CAS  Google Scholar 

  29. Tacke J, Mahnken AH, Gunther RW (2005) Percutaneous thermal ablation of renal neoplasms. Rofo 177: 1631–1640

    PubMed  CAS  Google Scholar 

  30. Vasudevan A, Davies RJ, Shannon BA et al. (2006) Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy. BJU Int 97: 946–949

    Article  PubMed  Google Scholar 

  31. Wolf JS jr (1998) Evaluation and management of solid and cystic renal masses. J Urol 159: 1120–1133

    Article  PubMed  Google Scholar 

  32. Wood BJ, Khan MA, Mcgovern F et al. (1999) Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. J Urol 161: 1470–1474

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Diagnostikzentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    M. Regier, J. Kemper, C. Nolte-Ernsting, P.G.C. Begemann & G. Adam

  2. Klinik und Poliklinik für Urologie, Zentrum für Operative Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    C. Eichelberg, H. Heinzer & H. Huland

  3. Klinik für Radiologische Diagnostik, RWTH Universität Aachen, Aachen, Deutschland

    A. Mahnken

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  1. M. Regier
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  2. J. Kemper
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  4. C. Nolte-Ernsting
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  9. G. Adam
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Correspondence to M. Regier.

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Regier, M., Kemper, J., Mahnken, A. et al. Stellenwert der CT-gesteuerten perkutanen Biopsie kleiner Tumoren in der Diagnostik des Nierenzellkarzinoms: aktueller Stand. Onkologe 14, 1022–1031 (2008). https://doi.org/10.1007/s00761-008-1484-0

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  • DOI: https://doi.org/10.1007/s00761-008-1484-0

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