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Renal Mass Core Biopsy: Accuracy and Impact on Clinical Management

¹ Department of Radiology, UH B1D407, University of Michigan Hospitals, Ann Arbor, MI.
² Present address: Department of Radiology, Stanford Hospital and Clinics, 300 Pasteur Dr., H1307, Stanford, CA 94305-5105.
³ Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, MI.
⁴ Department of Surgery-Urology, University of Michigan Hospitals, Ann Arbor, MI.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —81-year-old man with history of prostate cancer. Renal mass was detected on staging CT. Contrast-enhanced CT image obtained during biopsy with patient in prone position shows introducer needle penetrating mass. Biopsy of left renal mass revealed renal cell carcinoma.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —41-year-old woman with history of renal transplant for lupus nephritis. Coronal contrast-enhanced T1-weighted spoiled gradient-recalled acquisition in steady state (SPGR) image shows hypointense mass (arrow) in interpolar region of right lower quadrant transplant kidney. Biopsy revealed posttransplantation lymphoproliferative disorder.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —57-year-old man with enlarged cervical lymph nodes. Contrast-enhanced CT image reveals infiltrative mass (arrow) replacing right kidney and extending into perirenal fat. Biopsy revealed large B-cell lymphoma.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —56-year-old woman with no history of malignancy. Unenhanced CT image obtained with patient in prone position depicts low-attenuation right renal mass (arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —56-year-old woman with no history of malignancy. Biopsy image shows needle entering same region as that shown in A. Biopsy was nondiagnostic. Subsequent nephrectomy revealed renal cell carcinoma.

View larger version (27K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Diagram shows clinical categorization of 152 renal masses. Gray boxes indicate groups with biopsy results impacting clinical management. RFA = radiofrequency ablation, RCC = renal cell carcinoma, NOS = not otherwise specified.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —68-year-old woman with history of non-small cell lung cancer. Contrast-enhanced CT image shows large right renal mass with central low attenuation. Biopsy revealed renal cell carcinoma.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —79-year-old man with history of prostate cancer and lymphoma. Coronal oblique reformatted image from excretory phase of contrast-enhanced CT examination shows infiltrative soft-tissue mass surrounding right renal pelvis and proximal ureter (arrow). Biopsy of renal pelvis mass revealed recurrent large B-cell lymphoma. Large upper pole cyst (arrowhead) is incidentally noted.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —73-year-old woman with history of colon cancer. Contrast-enhanced CT image reveals exophytic mass (arrow) arising from malrotated left kidney. Comparison with unenhanced images (not shown) confirmed enhancement. Biopsy revealed oncocytoma. Mass has been stable in size for 5 years.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —31-year-old man with acute lymphocytic leukemia. Contrast-enhanced CT image shows low-attenuation left renal mass (arrow). Biopsy revealed "severe diffuse tubular injury/necrosis; focal viral cytopathic changes suggesting cytomegalovirus infection, no evidence of recurrent leukemia."

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —81-year-old woman with weight loss and questionable lytic lesion in spine (arrow). Contrast-enhanced CT image depicts right renal mass (arrowhead) containing several pixels measuring 0 H combined with enhancing soft-tissue components. Biopsy revealed benign angiomyolipoma.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —42-year-old man with single transient episode of acute renal failure. Subsequent contrast-enhanced CT image reveals multiple tiny bilateral low-attenuation renal masses. Biopsy was requested to evaluate lymphoma versus multiple renal cell carcinomas potentially related to von Hippel-Lindau syndrome. Biopsy revealed sarcoidosis.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —63-year-old man with no history of malignancy. Contrast-enhanced CT image shows low-attenuation right posterior renal mass (arrow). Biopsy revealed metastatic melanoma.

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