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1 Department of Radiology, Brigham and Women's Hospital and Harvard Medical
School, 75 Francis St., Boston, MA 02115.
2 Department of Pathology, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA 02115.
3 Department of Radiology, University of North Carolina at Chapel Hill, 2016 Old
Clinic Building, Campus Box 7510, Chapel Hill, NC 27599-7510.
OBJECTIVE. The purpose of our retrospective study was to evaluate the sensitivity and negative predictive value of percutaneous biopsy of renal masses stratified by clinical setting and the size of the mass.
MATERIALS AND METHODS. We categorized 115 consecutive percutaneous biopsies of renal masses in 113 patients into four clinical settings and three groups of mass sizes. The sensitivity and negative predictive value were computed (with 95% confidence intervals [CI]) for each clinical setting and for each size group.
RESULTS. For all procedures (n = 115), the sensitivity and negative predictive value were 90% (95% CI, 81-95%) and 64% (95% CI, 44-81%), respectively. For patients with a known malignancy who presented with a renal mass (n = 55), the sensitivity and negative predictive value were 90% (95% CI, 78-96%) and 38% (95% CI, 10-74%), respectively. For patients with no known malignancy and suspected unresectable tumor (n = 36), the sensitivity and negative predictive value were 92% (95% CI, 76-98%) and 0%, respectively. For patients with no known malignancy who presented with a cystic mass (n = 16), the sensitivity and negative predictive value were 33% (95% CI, 2-87%) and 87% (95% CI, 58-98%), respectively. For patients who were not surgical candidates with a renal cell carcinoma (n = 8) that was thought to be resectable, both the sensitivity and negative predictive value were 100%. For masses 3 cm and less (n = 31), the sensitivity and negative predictive value were 84% (95% CI, 63-95%) and 60% (95% CI, 27-86%), respectively. For masses between 4 and 6 cm (n = 42), the sensitivity and negative predictive value were 97% (95% CI, 83-100%) and 89% (95% CI, 51-99%), respectively. For masses greater than 6 cm (n = 42), the sensitivity and negative predictive value were 87% (95% CI, 71-95%) and 44% (95% CI, 15-77%), respectively.
CONCLUSION. Percutaneous renal mass biopsy has a high sensitivity in
three clinical settings: patients with a known malignancy, patients with no
known malignancy and suspected unresectable tumor, and nonsurgical patients
with a mass suspected to be a resectable renal cell carcinoma. Negative
results in small (
3 cm) and large (> 6 cm) masses should be viewed
with caution.
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