Abhinav Vij MBBS, MPH, Presenter: Nothing to Disclose

Luiz Siqueira, Abstract Co-Author: Nothing to Disclose

Ali Devrim Karaosmanoglu MD, Abstract Co-Author: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Research grant, Covidien AG

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated

Anthony Edward Samir MD, Abstract Co-Author: Nothing to Disclose

To evaluate the yield of repeat percutaneous image guided biopsy of focal renal lesions when the first biopsy is non-diagnostic.

An institutional database was searched to identify focal renal lesion biopsies performed over a ten-year period (January 1998 – December 2008). A retrospective review of electronic hospital records including interventional radiology reports, pathology reports, outpatient notes and discharge summaries was performed. The data gathered included size of lesion, type of lesion (solid vs. cystic), imaging modality used to perform biopsy, biopsy technique, histopathology results, and cytology results.

850 patients with 911 focal renal lesions were identified. 972 focal renal biopsies were performed in this cohort. Biopsies were obtained with a combined core and FNA technique performed through a coaxial needle system. There were 61 cases in which image-guided focal renal lesion biopsy was repeated following an initial non-diagnostic biopsy. A diagnostic result was obtained in 75% (46/61 cases). The histopathologic diagnoses obtained on repeat biopsy were renal cell carcinoma (51%, 31/61 cases), fibrous tissue (4.9%, 3 of 61 cases), oncocytoma (6.5%, 4 of 61 cases), cyst wall (4.9%, 3/61 cases), angiomyolipoma (3% 2/61 cases), focal nephritis (2%, 1/61 cases), transitional cell carcinoma (2%, 1/61 cases), metastatic carcinoma (2%, 1/61 cases). Biopsy results were non-diagnostic in 25% (15/61 cases). In 5% (3/61 cases), biopsy results showed “normal tissue.” These were included in the non-diagnostic category on the presumption that the renal lesion had not been biopsied. Repeat biopsy was non-diagnostic in 24% (9/37 cases) when the lesion was solid and in 25% (6/24 cases) when the lesion was cystic.

Repeat image guided focal renal lesion biopsy provides a specific pathologic diagnosis in the majority of cases when the first image-guided biopsy is non-diagnostic. The likelihood that a repeat renal biopsy will be diagnostic is the same for cystic and solid renal lesions.

A repeat image guided focal renal biopsy is appropriate clinical management in patients with a focal renal mass when the first renal biopsy is non-diagnostic.

Vij, A, Siqueira, L, Karaosmanoglu, A, Gervais, D, Mueller, P, Samir, A, Is It Worthwhile Repeating a Nondiagnostic Renal Lesion Biopsy? Lessons Learned in 972 Focal Renal Lesion Biopsies.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9012461.html