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The Non-Diagnostic Renal Mass Biopsy: What’s the Risk?
Glen W. Barrisford, M.D., Sameer M. Deshmukh, M.D., Manish Dhyani, M.D., Ron Arellano, M.D., Anthony Samir, M.D., Michael L. Blute, M.D., Adam S. Feldman, M.D..
Massachusetts General Hospital, Boston, MA, USA.

Background: Renal mass biopsy (RMB) is a diagnostic option for evaluation of a suspicious renal mass. A non-diagnostic RMB (NDRMB) offers little to resolve the diagnostic dilemma. We reviewed our RMB database to determine the predictors and outcomes of a NDRMB.
Methods: Retrospective review of 1000 RMBs (1997-2010) with IRB approval. Core needle biopsy and Fine Needle Aspiration were performed concurrently.
Results: Tumor size was 0-4cm (80%), >4-7cm (16%), >7cm (4%). 82% of lesions were solid (821) and 18% were cystic (179). 216/1000 (22%) had a NDRMB. Solid lesions had a NDRMB rate of 13% (104/821) compared with 63% (112/179) in cystic lesions (p<0.0001). The NDRMB rate increased with a decrease in tumor size (<2cm: 21%, 2-4cm: 9.5%, >4-7cm: 11%, >7cm: 6.3%; p<0.0001).
Of 216 tumors with an initial NDRMB, 55 underwent repeat biopsy with a diagnostic result in 58% (32/55): 47% (26/55) RCC, 5.5% (3/55) oncocytoma, and 3.6% (2/55) angiomyolipoma. 42% (23/55) remained non-diagnostic after repeat biopsy.
33/216 (15.3%) of masses with an initial NDRMB went to surgery: 91% (30/33) were RCC or other malignancy on surgical pathology.
Conclusions: Cystic lesions have a five-fold higher chance of a NDRMB than solid lesions. Lesions <2cm have the highest risk of a non-diagnostic biopsy result. Masses with a NDRMB still have a significant risk of malignancy and therefore must be treated or followed closely.
Outcomes of Non-Diagnostic Biopsies (n=216)
Lesions undergoing repeat biopsy55/216 (25.5%)
Diagnostic Repeat Biopsy32/55 (58%)
RCC or other malignancy26/55 (47%)
Oncocytoma/Oncocytic neoplasm3/55 (5.5%)
Angiomyolipoma2/55 (3.6%)
Non-Diagnostic Repeat Biopsy23/55 (42%)
Surgically treated after initial NDRMB33/216 (15.3%)
RCC or other malignancy30/33 (91%)


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