Journal of Ultrasound in Medicine, Vol 20, Issue 7 749-753, Copyright © 2001 by American Institute of Ultrasound in Medicine
Sonographically guided renal mass biopsy: indications and efficacy
P. T. Johnson, L. N. Nazarian, R. I. Feld, L. Needleman, A. S. Lev-Toaff, S. R. Segal and E. J. Halpern
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
PURPOSE: To review the clinical indications, pathologic results, and
success rate of all our sonographically guided solid renal mass biopsies
over a 5-year period. METHODS: Between 1993 and 1998, 44 consecutive
patients underwent sonographically guided percutaneous biopsy of a solid
renal mass. Indications included prior history of nonrenal malignancy,
metastatic disease of unknown primary origin, previous contralateral
nephrectomy for a renal cell neoplasm, a renal transplant mass, suspected
renal lymphoma, history of tuberous sclerosis, and poor surgical candidacy.
Aspiration biopsies were initially performed with 22- to 18-gauge spinal
needles. If the initial cytologic evaluation findings were nondiagnostic,
core biopsies were then performed with 20- to 18-gauge core biopsy guns.
Dictated sonographic reports of the biopsies were reviewed to determine the
following: indication for biopsy, location and size of the renal mass,
needle gauge and type, number of needle passes, and complications. Final
cytologic and surgical pathologic records were reviewed. RESULTS:
Thirty-six (82%) of the 44 biopsy specimens were diagnostic. Aspirated
smears were diagnostic in 24 (67%) of these cases, with the diagnosis made
on the basis of cell block alone in an additional 2 (6%). A definitive
diagnosis came from core biopsy alone in 10 cases (28%). The 18-gauge core
needle yielded diagnostic results more reliably than the 20-gauge core
needle, and a significant correlation was seen between core biopsy needle
size and the rate of diagnostic core samples (P = .017). Pathologic
diagnoses included renal cell carcinoma (n = 18), lymphoma (n = 4),
oncocytic neoplasm (n = 4), transitional cell carcinoma (n = 2),
angiomyolipoma (n = 1), papillary cortical neoplasm (n = 1), and metastatic
carcinoma (n = 6). Complications were seen in 4 (9%) of 44 cases; all were
treated conservatively. CONCLUSIONS: For specific clinical indications,
sonographically guided fine-needle aspiration and core biopsy of a solid
renal mass can be performed safely. In many cases, a definitive diagnosis
can be made on the basis of fine-needle aspiration alone. However,
diagnosis may ultimately require core biopsy, for which 18-gauge core
needles would be more reliably diagnostic than 20-gauge needles.
