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Renal Mass Biopsy: Does Fine Needle Aspiration Add Value?
Glen W. Barrisford, MD, Sameer M. Deshmukh, MD, Manish Dhyani, MD, Ron Arellano, MD, Anthony Samir, MD, Michael L. Blute, MD, Adam S. Feldman, MD.
Massachusetts General Hospital, Boston, MA, USA.
Background: Renal mass biopsy (RMB) can be used to evaluate small renal masses (SRM). Techniques include core needle biopsies (CNB) and fine needle aspiration (FNA). We reviewed our database to assess the utility of FNA over that of CNB.
Materials & Methods: Retrospective review of 1000 RMBs (1997-2010). Lesions referred for ablative therapy were biopsied routinely. CNB’s were performed using 15-18 gauge coaxial needles; FNA’s were performed with 20-23 gauge Chiba needles.
Results: Median age, 66 yrs IQR [56,76], 63% were male. CNB and FNA were performed concurrently in 94%. Tumor size was ≤4cm in 80%, >4-7cm 16%, >7cm 4%. Lesion composition was solid in 82% and cystic in 18%. Biopsies were performed with computed tomography in 92% and ultrasound guidance in 8%.
Diagnostic rates and biopsy techniques are presented in Table 1.
Of 1000 lesions biopsied, surgical pathology was available for 277. Pathology in solid lesions correlated with CNB in 87% and FNA in 45%. In cystic lesions, pathology correlated with CNB in 78%, and FNA in 32%.
Conclusions: CNB demonstrates a higher diagnostic rate and better surgical pathology correlation as compared to FNA. Nevertheless, in the setting of a non-diagnostic CNB, FNA provided informative information in 13% of all lesions and 22% of solid lesions. These data support the inclusion of FNA combined with CNB in a RMB protocol. | | | | | | | | | Table 1 | | Biopsy Conditions | Diagnostic rate (All lesions) | Diagnostic rate (Solid lesions) | Diagnostic rate (Cystic lesions) | | Core Needle Biopsy (CNB) | 78% | 86% | 37% | | Fine Needle Aspiration (FNA) | 55% | 63% | 21% | | CNB is diagnostic, and FNA is diagnostic | 67% | 69% | 51% | | CNB is not diagnostic, and FNA is diagnostic | 13% | 22% | 3.80% | | | |
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