Purpose Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass >= 4 cm, to evaluate treatment deviation. Methods Between 2008 and 2017, 102 patients with a solid renal mass >= 4 cm with no distant metastases underwent preliminary renal tumor biopsy. We investigated the proportion of patients who proceeded with radical nephrectomy, variables predicting non-renal cell carcinoma (RCC) and concordance between biopsy findings and definitive pathology. Results Median tumor size was 70 mm (IQR 55-110). Clinical stage was cT1b in 41, cT2 in 33, cT3 in 25 and cT4 in three patients. A median of three (IQR 2-3) renal tumor biopsies were taken with 16/18 Gauge needles in 97% of cases. Clavien grade I complications occurred in five cases. Malignant tumors were documented in 84 patients: 78 RCCs and six non-RCCs. Fifteen biopsies documented oncocytoma and three were non-diagnostic. Grade was reported in 50 RCCs: 42 (84%) were low and eight (16%) high grade. Eighty-three patients proceeded with radical nephrectomy; six non-RCC malignant tumors underwent combined and/or intensified treatment; 13 of 15 patients with oncocytoma did not undergo radical nephrectomy (eight underwent observation). Definitive pathology confirmed diagnosis in all cases. Grade concordance was 84%, considering two tiers (high vs low grade). No preoperative clinical variable predicted definitive pathology. Conclusions Renal tumor biopsy is a safe procedure that leads to radical nephrectomy in most tumors >= 4 cm. Nonetheless, 20% of patients exhibited non-RCC histology. Renal tumor biopsy should be considered in this setting.

Renal tumor biopsy in patients with cT1b-T4-M0 disease susceptible to radical nephrectomy: analysis of safety, accuracy and clinical impact on definitive management / S. Nazzani, C. Zaborra, D. Biasoni, M. Catanzaro, A. Macchi, S. Stagni, A. Tesone, T. Torelli, R. Lanocita, T. Cascella, C. Morosi, C. Spreafico, M. Colecchia, A. Marchianò, E. Montanari, R. Salvioni, N. Nicolai. - In: SCANDINAVIAN JOURNAL OF UROLOGY. - ISSN 2168-1805. - (2022), pp. 1-6. [Epub ahead of print] [10.1080/21681805.2022.2092549]

Renal tumor biopsy in patients with cT1b-T4-M0 disease susceptible to radical nephrectomy: analysis of safety, accuracy and clinical impact on definitive management

S. Nazzani
Primo
;
E. Montanari;
2022

Abstract

Purpose Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass >= 4 cm, to evaluate treatment deviation. Methods Between 2008 and 2017, 102 patients with a solid renal mass >= 4 cm with no distant metastases underwent preliminary renal tumor biopsy. We investigated the proportion of patients who proceeded with radical nephrectomy, variables predicting non-renal cell carcinoma (RCC) and concordance between biopsy findings and definitive pathology. Results Median tumor size was 70 mm (IQR 55-110). Clinical stage was cT1b in 41, cT2 in 33, cT3 in 25 and cT4 in three patients. A median of three (IQR 2-3) renal tumor biopsies were taken with 16/18 Gauge needles in 97% of cases. Clavien grade I complications occurred in five cases. Malignant tumors were documented in 84 patients: 78 RCCs and six non-RCCs. Fifteen biopsies documented oncocytoma and three were non-diagnostic. Grade was reported in 50 RCCs: 42 (84%) were low and eight (16%) high grade. Eighty-three patients proceeded with radical nephrectomy; six non-RCC malignant tumors underwent combined and/or intensified treatment; 13 of 15 patients with oncocytoma did not undergo radical nephrectomy (eight underwent observation). Definitive pathology confirmed diagnosis in all cases. Grade concordance was 84%, considering two tiers (high vs low grade). No preoperative clinical variable predicted definitive pathology. Conclusions Renal tumor biopsy is a safe procedure that leads to radical nephrectomy in most tumors >= 4 cm. Nonetheless, 20% of patients exhibited non-RCC histology. Renal tumor biopsy should be considered in this setting.
oncocytoma; radical nephrectomy; renal cell carcinoma; Renal neoplasms; tumor biopsy;
Settore MED/24 - Urologia
23-giu-2022
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/933369
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