Percutaneous renal mass biopsy: historical perspective, current status, and future considerations

ABSTRACT

Introduction: Percutaneous renal mass biopsy has evolved over the last decade with improvements on previous pitfalls including low tissue yield, high non-diagnostic rates, and complications. As understanding of tumor biology and natural history of renal cortical neoplasms has improved, percutaneous renal mass biopsy is poised to have an expanding role in an area characterized by individualized management and refined risk stratification.

Areas covered: This review summarizes the evolution of renal mass biopsy to its current state with respect to outcomes, indications, and clinical guidelines.

Expert opinion: With improved understanding of differential biological potential of renal cortical neoplasms combined with technical improvements in diagnostic yield and accuracy, utilization of renal mass biopsy is becoming an important adjunct to patient care in a broad range of clinical scenarios, including active surveillance, thermal ablation, and use of primary systemic therapy in localized and advanced settings.

KEYWORDS:

• Active surveillance
• carcinoma
• renal cell
• neoadjuvant
• renal mass biopsy; thermal ablation

Article highlights

• Increased clinical detection of small renal masses represents an expanding indication for renal mass biopsy.

• Renal mass biopsy may be performed under CT or ultrasound guidance in the outpatient setting with local anesthesia.

• Core biopsies should be performed due to the enhanced diagnostic yield compared to fine needle aspiration.

• Renal mass biopsy has a diagnostic rate of 92%, and sensitivity and specificity of core biopsies of 99.1% and 99.7%, respectively.

• Renal mass biopsy is less accurate at predicting tumor grade when a four-tiered system is used, but accuracy is enhanced when differentiating between high and low-grade tumors.

• Complications of renal mass biopsy are estimated to occur in approximately 4% of the cases, with few clinically significant sequelae.

• Small renal masses are more often benign than large masses and represent an expanding indication for biopsy, particularly of the SMR identified incidentally in a surgically high-risk patient.

• Renal mass biopsy is indicated prior to ablative therapies.

• Further prognostication in malignant or metastatic disease may be possible from renal tumor biopsy with molecular biomarkers.

Declaration of interest

I. Derweesh reports being an investigator for Pfizer and Genentech, as well as acting as a consultant for Intuitive. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.