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Evolving Role of Renal Mass Biopsy: Myths, Facts, and Misconceptions

  • J. Stuart WolfJr.Email author
Chapter
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Abstract

There are four reasons commonly offered by those opposed to the application of renal mass biopsy (RMB): (1) RMB is not useful because the lesion is almost certainly cancer; (2) RMB is not necessary because noninvasive techniques (i.e., cross-sectional imaging) are accurate enough to determine the risk of malignancy; (3) RMB is not safe; (4) RMB is not accurate. These are myths that can easily be debunked. There are three primary benefits to performing RMB: (1) RMB can help avoid intervention in cases of benign or nonaggressive tumor; (2) RMB may change the treatment plan if an unexpectedly aggressive renal malignancy is determined; (3) RMB might provide more assurance to both physician and patient regarding an active surveillance management plan. Overall, RMB should be considered in settings where this information would be useful, which is consistent with contemporary guidelines for the management of localized renal cancer. RMB is less useful in some patients at the extremes, such as an ill patient with a small renal mass where only an unusually aggressive malignancy would pose a threat or a patient with a long life expectancy and a larger renal mass where the lifetime risk of a missed malignancy is significant. In many patients, however, especially those aged 55–75 years and with masses 2–4 cm in size, RMB should be routinely offered.

Keywords

Renal (kidney) cancer  Biopsy  Pathology  Nephrectomy  Surveillance  Risk stratification 

References

  1. 1.
    Leppert JT, Hanley J, Wagner TH, Chung BI, Srinivas S, Chertow GM, et al. Utilization of renal mass biopsy in patients with renal cell carcinoma. Urology. 2014;83(4):774–80.CrossRefGoogle Scholar
  2. 2.
    Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170(6):2217–20.CrossRefGoogle Scholar
  3. 3.
    Lane BR, Gill IS. 5-year outcomes of laparoscopic partial nephrectomy. J Urol. 2007;177(1):70–4.CrossRefGoogle Scholar
  4. 4.
    Murphy AM, Buck AM, Benson MC, McKiernan JM. Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades. Urology. 2009;73(6):1293–7.CrossRefGoogle Scholar
  5. 5.
    Jeon HG, Lee SR, Kim KH, Oh YT, Cho NH, Rha KH, et al. Benign lesions after partial nephrectomy for presumed renal cell carcinoma in masses 4 cm or less: prevalence and predictors in Korean patients. Urology. 2010;76(3):574–9.CrossRefGoogle Scholar
  6. 6.
    Johnson DC, Vukina J, Smith AB, Meyer A-M, Wheeler SB, Kuo T-M, et al. Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol. 2015;193(1):30–5.CrossRefGoogle Scholar
  7. 7.
    Thompson RH, Kurta JM, Kaag M, Tickoo SK, Kundu S, Katz D, et al. Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol. 2009;181(5):2033–6.CrossRefGoogle Scholar
  8. 8.
    Nguyen MM, Gill IS. Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol. 2009;181(3):1020–7.CrossRefGoogle Scholar
  9. 9.
    Thompson RH, Hill JR, Babayev Y, Cronin A, Kaag M, Kundu S, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol. 2009;182(1):41–5.CrossRefGoogle Scholar
  10. 10.
    Kang SK, Zhang A, Pandharipande PV, Chandarana H, Braithwaite RS, Littenberg B. DWI for renal mass characterization: systematic review and meta-analysis of diagnostic test performance. Am J Roentgenol. 2015;205(2):317–24.CrossRefGoogle Scholar
  11. 11.
    Patel HD, Johnson MH, Pierorazio PM, Sozio SM, Sharma R, Iyoha E, et al. Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature. J Urol. 2016;195(5):1340–7.CrossRefGoogle Scholar
  12. 12.
    Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016;69(4):660–73.CrossRefGoogle Scholar
  13. 13.
    Sun MRM, Ngo L, Genega EM, Atkins MB, Finn ME, Rofsky NM, et al. Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes—correlation with pathologic findings. Radiology. 2009;250(3):793–802.CrossRefGoogle Scholar
  14. 14.
    Gorin MA, Rowe SP, Baras AS, Solnes LB, Ball MW, Pierorazio PM, et al. Prospective evaluation of 99mTc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic / chromophobe tumors. Eur Urol. 2016;69(3):413–6.CrossRefGoogle Scholar
  15. 15.
    Egbert ND, Caoili EM, Cohan RH, Davenport MS, Francis IR, Kunju LP, et al. Differentiation of papillary renal cell carcinoma subtypes on CT and MRI. Am J Roentgenol. 2013;201(2):347–55.CrossRefGoogle Scholar
  16. 16.
    Young JR, Coy H, Douek M, Lo P, Sayre J, Pantuck AJ, et al. Type 1 papillary renal cell carcinoma: differentiation from Type 2 papillary RCC on multiphasic MDCT. Abdominal Radiol. 2017;42(7):1911–8.CrossRefGoogle Scholar
  17. 17.
    Takacova M, Bartosova M, Skvarkova L, Zatovicova M, Vidlickova I, Csaderova L, et al. Carbonic anhydrase IX is a clinically significant tissue and serum biomarker associated with renal cell carcinoma. Oncol Lett. 2013;5(1):191–7.CrossRefGoogle Scholar
  18. 18.
    Morrissey JJ, Mellnick VM, Luo J, Siegel MJ, Figenshau RS, Bhayani S, et al. Evaluation of urine aquaporin-1 and perilipin-2 concentrations as biomarkers to screen for renal cell carcinoma: a prospective cohort study. JAMA Oncol. 2015;1(2):204–12.CrossRefGoogle Scholar
  19. 19.
    Herts BR. Imaging guided biopsies of renal masses. Curr Opin Urol. 2000;10(2):105–9.CrossRefGoogle Scholar
  20. 20.
    Mullins JK, Rodriguez R. Renal cell carcinoma seeding of a percutaneous biopsy tract. Can Urol Assoc J. 2013;7:E176–9.CrossRefGoogle Scholar
  21. 21.
    Viswanathan A, Ingimarsson JP, Seigne JD, Schned AR. A single-centre experience with tumour tract seeding associated with needle manipulation of renal cell carcinomas. Can Urol Assoc J. 2015;9(11-12):E890–E3.CrossRefGoogle Scholar
  22. 22.
    Soares D, Ahmadi N, Crainic O, Boulas J. Papillary renal cell carcinoma seeding along a percutaneous biopsy tract. Case Rep Urol. 2015;2015:925254.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Chang DTS, Sur H, Lozinskiy M, Wallace DMA. Needle tract seeding following percutaneous biopsy of renal cell carcinoma. Korean J Urol. 2015;56(9):666–9.CrossRefGoogle Scholar
  24. 24.
    Andersen MFB, Norus TP. Tumor seeding with renal cell carcinoma after renal biopsy. Urol Case Rep. 2016;9:43–4.CrossRefGoogle Scholar
  25. 25.
    Richard PO, Jewett MAS, Bhatt JR, Kachura JR, Evans AJ, Zlotta AR, et al. Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol. 2016;68(6):1007–13.CrossRefGoogle Scholar
  26. 26.
    Halverson SJ, Kunju LP, Bhalla R, Gadzinski AJ, Alderman M, Miller DC, et al. Accuracy of determining small renal mass management with risk stratified biopsies: confirmation by final pathology. J Urol. 2013;189(2):441–6.CrossRefGoogle Scholar
  27. 27.
    Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53.CrossRefGoogle Scholar
  28. 28.
    Kutikov A, Smaldone MC, Egleston BL, Manley BJ, Canter DJ, Simhan J, et al. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol. 2011;60(2):241–8.CrossRefGoogle Scholar
  29. 29.
    Osawa T, Hafez KS, Miller DC, Montgomery JS, Morgan TM, Palapattu GS, et al. Comparison of percutaneous renal mass biopsy and R.E.N.A.L. nephrometry score nomograms for determining benign vs malignant disease and low-risk vs high-risk renal tumors. Urology. 2016;96:87–92.CrossRefGoogle Scholar
  30. 30.
    Osawa T, Hafez KS, Miller DC, Montgomery JS, Morgan TM, Palapattu GS, et al. Age, gender and R.E.N.A.L. nephrometry score do not improve the accuracy of a risk stratification algorithm based on biopsy and mass size for assigning surveillance versus treatment of renal tumors. J Urol. 2016;195(3):574–80.CrossRefGoogle Scholar
  31. 31.
    Hawken SR, Krishnan NK, Ambani SN, Montgomery JS, Caoili EM, Ellis JH, et al. Effect of delayed resection after initial surveillance and tumor growth rate on final surgical pathology in patients with small renal masses (SRMs). Urol Oncol. 2016;34(11):486.e9–e15.CrossRefGoogle Scholar
  32. 32.
    Montgomery JS, Krishnan NK, Hawken SR, Ambani SN, Morgan TM, Hafe KS, et al. Renal mass biopsy influences the management of small renal masses [MP21-2]. J Endourol. 2015;29:A162.CrossRefGoogle Scholar
  33. 33.
    Crispen PL, Viterbo R, Fox EB, Greenberg RE, Chen DYT, Uzzo RG. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer. 2008;112(5):1051–7.CrossRefGoogle Scholar
  34. 34.
    Pierorazio PM, Johnson MH, Ball MW, Gorin MA, Trock BJ, Chang P, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol. 2015;68(3):408–15.CrossRefGoogle Scholar
  35. 35.
    Ambani SN, Morgan TM, Montgomery JS, Gadzinski AJ, Jacobs BL, Hawken S, et al. Predictors of delayed intervention for patients on active surveillance for small renal masses: does renal mass biopsy influence our decision? Urology. 2016;98:88–96.CrossRefGoogle Scholar
  36. 36.
    Morgan TM, Mehra R, Tiemeny P, Wolf JS Jr, Wu S, Sangale Z, et al. A multigene signature based on cell cycle proliferation improves prediction of mortality within 5 yr of radical nephrectomy for renal cell carcinoma. Eur Urol. 2018;73(5):763–9.CrossRefGoogle Scholar
  37. 37.
    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.CrossRefGoogle Scholar
  38. 38.
    Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017;198(3):520–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery and Perioperative CareDell Medical School at the University of Texas at AustinAustinUSA

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