Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable?

Springer Science and Business Media LLC - Tập 42 Số 3 - Trang 319-325 - 2024
Toshihiro Iguchi1, Yusuke Matsui2, Tomohiro Toji3, Jun Sakùrai4, Koji Tomita1, Mayu Uka1, Noriyuki Umakoshi1, Takahiro Kawabata1, Kazuaki Munetomo1, Toshiharu Mitsuhashi4, Takao Hiraki2
1Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558, Japan
2Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
3Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan
4Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

Tóm tắt

Abstract Purpose

This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy.

Materials and methods

Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6–5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. “First specimen” and “all specimens” were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists.

Results

Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020).

Conclusion

Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.

Từ khóa


Tài liệu tham khảo

Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98:1331–4.

Iguchi T, Hiraki T, Matsui Y, Fujiwara H, Sakurai J, Masaoka Y, et al. CT fluoroscopy-guided renal tumor cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure. Eur Radiol. 2018;28:283–90.

Richard PO, Jewett MA, 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. 2015;68:1007–13.

Wang R, Wolf JS Jr, Wood DP Jr, Higgins EJ, Hafez KS. Accuracy of percutaneous core biopsy in management of small renal masses. Urology. 2009;73:586–90.

Kim MH. CT-guided biopsy of entirely endophytic small renal masses: diagnostic rates and complications using standard-dose and reduced-dose CT protocols. AJR Am J Roentgenol. 2017;208:1030–6.

Castle SM, Gorin MA, Gorbatiy V, Leveillee RJ. Preoperative patient counseling for diagnostic renal biopsy and complications with renal radiofrequency ablation. World J Urol. 2013;31:1105–10.

Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Tanaka T, et al. Image-guided core biopsy of 2-cm or smaller renal tumors. Diagn Interv Imaging. 2020;101:715–20.

EAU guidelines on renal cell carcinoma. https://uroweb.org/guideline/renal-cell-carcinoma/#5

Tsivian M, Rampersaud EN Jr, del Pilar Laguna Pes M, Joniau S, Leveillee RJ, Shingleton WB, et al. Small renal mass biopsy-how, what and when: report from an international consensus panel. BJU Int. 2014;113:854–63.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

Hobbs DJ, Zhou M, Campbell SC, Aydin H, Weight CJ, Lane BR. The impact of location and number of cores on the diagnostic accuracy of renal mass biopsy: an ex vivo study. World J Urol. 2013;31:1159–64.

Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology. 2003;226:417–24.

Shiraishi A, Matsui Y, Munetomo K, Kojima K, Toji T, Higaki F, et al. A case of capillary renal hemangioma imaged by 4D-CT. Rinsho hoshasen. 2023;68:197–200 [Japanese].

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;69:660–73.

Posielski NM, Bui A, Wells S, Best SL, Gettle LM, Ziemlewicz TJ, et al. Risk factors for complications and nondiagnostic results following 1155 consecutive percutaneous core renal mass biopsies. J Urol. 2019;201:1080–7.

Park SY, Park BK, Kim CK, Kwon GY. Ultrasound-guided core biopsy of small renal masses: diagnostic rate and limitations. J Vasc Interv Radiol. 2013;24:90–6.

Breda A, Treat EG, Haft-Candell L, Leppert JT, Harper JD, Said J, et al. Comparison of accuracy of 14-, 18- and 20-G needles in ex-vivo renal mass biopsy: a prospective, blinded study. BJU Int. 2010;105:940–5.

Rybicki FJ, Shu KM, Cibas ES, Fielding JR, vanSonnenberg E, Silverman SG. Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol. 2003;180:1281–7.

Rapp DE, Orvieto M, Sokoloff MH, Shalhav AL. Use of biopsy sheath to improve standardization of renal mass biopsy in tissue-ablative procedures. J Endourol. 2004;18:453–4.

Wunderlich H, Hindermann W, Mustafa AMA, Reichelt O, Junker K, Schubert J. The accuracy of 250 fine needle biopsies of renal tumors. J Urol. 2005;174:44–6.

Wu JS, Goldsmith JD, Horwich PJ, Shetty SK, Hochman MG. Bone and soft-tissue lesions: what factors affect diagnostic yield of image-guided core-needle biopsy? Radiology. 2008;248:962–70.

Fishman JE, Milikowski C, Ramsinghani R, Velasquez MV, Aviram G. US-guided core-needle biopsy of the breast: how many specimens are necessary? Radiology. 2003;226:779–82.