DOI:10.2214/AJR.07.2128
AJR 2007; 189:W168
© American Roentgen Ray Society
Renal Mass Core Biopsy
Paola Tombesi,
Mirella Catellani and
Sergio Sartori
St. Anna Hospital Ferrara, Italy
WEB—This is a Web exclusive article.
We read with great interest the article by Maturen et al.
[1] about renal mass core
biopsy. In a retrospective review of 152 imaging-guided biopsies of renal
masses, they performed multiple (up to four) passes of an 18-gauge cutting
needle, obtaining diagnostic specimens in 96% of biopsies performed.
Sensitivity for malignancy was 97.7% and specificity was 100%. Immediate and
delayed complications were 1.3% and 0.7%, respectively. The authors concluded
that the technique is safe and highly sensitive and can significantly affect
clinical management. We strongly agree with their conclusions.
From January 2003 to June 2006, we performed 32 biopsies of suspicious
renal masses (mean diameter, 4.5 cm; range, 2.5–11 cm) with inconclusive
imaging findings. Twenty lesions were solid with colliquative or necrotic
areas; 12 were partially or predominantly cystic. Low-mechanical-index
contrast-enhanced sonography was used to identify viable tissue and to guide
the placement of an 18-gauge cutting needle into viable portions of the
lesions. One needle pass was performed in 24 cases, and two needle passes were
performed in eight. All patients underwent control sonography 6 hours after
the biopsy was performed.
One (3.1%) biopsy result was nondiagnostic, 22 biopsies (68.8%) were
positive for malignancy (12 renal cell carcinomas [RCCs], four lymphomas,
three metastases, and three undefined carcinomas), and nine (28.1%) revealed
benign lesions (two pyelonephritis, two abscesses, two hemorrhagic cysts, one
infarct, one tuberculosis, and one cystic dysplasia). No immediate or delayed
complications were observed. The patient with the nondiagnostic biopsy
underwent nephrectomy, and surgical pathology revealed a widely necrotic RCC.
All diagnoses of benign and malignant lesions were confirmed by surgery or
clinical and imaging follow-up (median, 18 months; range, 8–40 months).
Biopsy findings avoided unnecessary nephrectomy in 14 patients (43.8%).
Our results are quite similar to those of Maturen et al.
[1], but in our series fewer
needle passes were needed to obtain diagnostic specimens. Contrast-enhanced
sonographic guidance is likely to have played a key role in this regard.
Contrast-enhanced sonography allows real-time imaging of microcirculation,
enabling differentiation of viable from necrotic tissue and detection of
residual viable foci of hepatocellular carcinomas after radiofrequency
ablation [2]. Such an ability
to identify viable tissue can also be useful in reducing the rate of
nondiagnostic biopsies of predominantly necrotic or cystic lesions. Some years
ago we successfully exploited this ability to guide transthoracic biopsy of a
widely necrotic lung neoplasm after conventional sonography-guided biopsy
failed to yield an adequate diagnostic sample
[3].
The number of needle passes is considered a risk factor affecting the
frequency of complications of liver biopsy
[4], and it has also been
reported to represent a risk factor in percutaneous renal biopsy
[5]. Although there may have
been some bias because our series was small, our results suggest that
contrast-enhanced sonography can enable the achievement of a high rate of
diagnostic specimens with a low number of needle passes. In our opinion,
contrast-enhanced sonography should be regarded as the method of choice to
guide percutaneous biopsy of renal masses, particularly when they are
predominantly necrotic or cystic, whenever an adequate acoustic window can be
identified.
References
- Maturen KE, Nghiem HV, Caoili EM, Higgins EG, Wolf JS Jr, Wood DP
Jr. Renal mass core biopsy: accuracy and impact on clinical management.
AJR 2007; 188:563
-570[Abstract/Free Full Text]
- Bartolozzi C, Crocetti L, Cioni D, Donati FM, Lencioni R.
Assessment of therapeutic effect of liver tumor ablation procedures.
Hepatogastroenterology 2001;48
: 352-358[Medline]
- Sartori S, Nielsen I, Trevisani L, Tombesi P, Ceccotti PC,
Abbasciano V. Contrast-enhanced sonography as guidance for transthoracic
biopsy of a peripheral lung lesion with large necrotic areas. J
Ultrasound Med 2004; 23:133
-136[Free Full Text]
- Kim SH, Lim HK, Lee J, Cho JM, Jang HJ. Needletract implantation in
hepatocellular carcinoma: frequency and CT findings after biopsy with a
19.5-gauge automated biopsy gun. Abdom Imaging2000; 25:246
-250[CrossRef][Medline]
- Prakash J, Singh M, Tripathi K, Rai US. Complications of
percutaneous renal biopsy. J Indian Med Assoc1994; 92:395
-396[Medline]
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