Incidental renal masses: Therapeutic management

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 153-155
Author(s):  
A. Prati ◽  
C. Cantoni ◽  
I. Pieri ◽  
P. Sacchini ◽  
A. Savino ◽  
...  
Keyword(s):  
Renal Mass ◽  
Percutaneous Biopsy ◽  
Imaging Studies ◽  
Benign Lesions ◽  
Renal Masses ◽  
Traditional Treatment ◽  
Radiologic Imaging ◽  
Management Alternatives ◽  
Total Nephrectomy

Evaluation and treatment of incidental renal masses is a problem facing urologists with increasing frequency since radiologic imaging (Echotomography and CT) has become routine. Traditional treatment by total nephrectomy may be unnecessary for small renal cell carcinoma and is often inappropriate for benign, lesions: whereas only observation by periodic follow-up with imaging studies and/or percutaneous biopsy is not always sufficient. So the problem of management alternatives is very important and no universal strategy can be employed. We report our experience with 15 pts with incidental renal mass treated in different ways.

Advantages and Challenges of Using Breast Biopsy Markers

2021 ◽  
Author(s):  
Taghreed I Alshafeiy ◽  
Alison Matich ◽  
Carrie M Rochman ◽  
Jennifer A Harvey
Keyword(s):  
Breast Biopsy ◽  
Percutaneous Biopsy ◽  
Standard Of Care ◽  
Benign Lesions ◽  
Accurate Identification ◽  
Biopsy Tissue ◽  
Local Practices ◽  
Frequency Of Use ◽  
Lesion Localization

Abstract Percutaneous image-guided biopsy procedures are the standard of care for histologic assessment of suspicious breast lesions. Post-biopsy tissue markers (clips) optimize patient management by allowing for assessment on follow-up imaging and precise lesion localization. Markers are used to ensure accurate correlation between imaging modalities, guide preoperative localization for malignant and high-risk lesions, and facilitate accurate identification of benign lesions at follow-up. Local practices differ widely, and there are no data detailing the exact frequency of use of clips for different breast biopsies. There are many indications for biopsy marker deployment, and some difficulties may be encountered after placement. The placement of biopsy markers has many advantages and few disadvantages, such that deployment should be routinely used after percutaneous biopsy procedures with rare exception.

scholarly journals Endoscopic ultrasound-guided trans-duodenal fine-needle biopsy of a small renal mass: case report and review of the literature

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Justin Kwong ◽  
Gary May ◽  
Michael Ordon
Keyword(s):  
Case Report ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Renal Mass ◽  
Percutaneous Biopsy ◽  
Fine Needle Biopsy ◽  
Renal Masses ◽  
Fine Needle ◽  
Renal Hilum ◽  
Grade 3

Abstract Background The incidental detection of small renal masses (SRMs) is increasing and biopsy to obtain pathological diagnosis is increasingly proposed as a diagnostic tool to guide further management. Renal mass biopsies are traditionally performed via a percutaneous approach. However, this is not always feasible due to anatomical limitations. A rarely reported alternative biopsy approach for SRMs is endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB). Herein, we describe a case of EUS-guided trans-duodenal FNB for a SRM that was not amenable to standard percutaneous biopsy. Case presentation A 48-year-old man was incidentally found to have a right-sided SRM measuring 2.9 × 2.2 × 2.4 cm during evaluation for a hernia. It was anterior, interpolar, completely endophytic and near the renal hilum. The tumor was not amenable to traditional percutaneous biopsy due to its anterior location. However, the renal mass was in close proximity to the descending duodenum and so it was felt that an EUS-guided trans-duodenal FNB would be feasible. The procedure was successful without any complications. The specimen adequacy was satisfactory for evaluation and consistent with renal papillary carcinoma with WHO/ISUP grade 3 nuclear changes. Conclusion Our case report demonstrated that EUS-guided trans-duodenal FNB was a safe and feasible approach to obtaining biopsy tissue diagnosis of a SRM that was not amenable to percutaneous biopsy.

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

66 Significance of Percutaneous Biopsy in the Clinical Management of Renal Masses

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
W Cheah ◽  
S D B Marques ◽  
A Bhuvanagiri ◽  
A Kailasa ◽  
M Thangavelu ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Management ◽  
Renal Mass ◽  
Percutaneous Biopsy ◽  
Final Analysis ◽  
Health Board ◽  
Renal Masses ◽  
Renal Mass Biopsy

Abstract Aim Percutaneous renal mass biopsy is increasingly used in the management of renal masses. The objective of our study was to determine the significance of percutaneous renal mass biopsy and its impact on clinical management. Method Retrospective study of all patients who had image guided percutaneous renal mass biopsy health-board wide from April 2011 to April 2019. Renal mass biopsies were performed for either a localised or metastatic renal mass. Results of the renal biopsies were compared to final diagnosis to determine diagnostic accuracy measured by sensitivity, specificity, negative predictive value and positive predictive value. Results Out of 429 patients who had a renal biopsy, 91 patients- 55 males (61%) and 36 females (39%) were included in the final analysis. The mean age of the study population was 66 years (range 46-87). Renal mass biopsies were performed using coaxial 18-gauge core needle technique. We categorised patients into two groups (metastatic renal masses and localised renal mass). Sixty-eight patients had biopsies for metastatic disease and 23 patients had biopsies for a localised renal mass. In the localised disease group, the sensitivity was 100%, positive predictive value was 82% (95% CI, 48.2-97.7%) and the negative predictive value was 100% (95% CI, 66.4-100%) (Clopper Pearson Method). For patients with metastatic renal mass the positive predictive value was 83%. Conclusions Percutaneous renal mass biopsy may have a role for metastatic renal cancers that require targeted therapy and localised masses that require curative treatment.

scholarly journals Extensive renal infarction following percutaneous biopsy of a small renal mass: A case report

2013 ◽  
Vol 7 (1-2) ◽  
pp. 118
Author(s):  
Samuel Abourbih ◽  
Saad Aldousari ◽  
Fadi Brimo ◽  
Atilla Omeroglu ◽  
Wassim Kassouf
Keyword(s):  
Renal Mass ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Percutaneous Biopsy ◽  
Renal Infarction ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Percutaneous Renal Biopsy ◽  
Nephron Sparing ◽  
Solid Renal Mass

Percutaneous renal biopsy has become increasingly utilized particularly in patients undergoing active surveillance for small renal masses. We present a case of a significant complication following biopsy of a solid renal mass in a patient who was recently diagnosed with laryngeal squamous cell carcinoma. The patient was planned for nephron sparing surgery that was converted to radical nephrectomy due to extensive renal infarction secondary to significant subcapsular hemorrhage inflicted by the biopsy.

Utility of Renal Mass Biopsy in a UK Tertiary Referral Centre

2012 ◽  
Vol 5 (5) ◽  
pp. 216-223 ◽  
Author(s):  
Thomas J. Walton ◽  
Carolyn Amery ◽  
David Moore ◽  
Nicholas J. Mayer ◽  
Arumugam Rajesh ◽  
...  
Keyword(s):  
Renal Mass ◽  
Percutaneous Biopsy ◽  
Accurate Method ◽  
Nuclear Grade ◽  
Bleeding Complications ◽  
Tertiary Referral Centre ◽  
Renal Masses ◽  
Surgical Specimen ◽  
Underlying Malignancy ◽  
Renal Mass Biopsy

Objective: To determine the value of percutaneous biopsy in a UK cohort of patients with renal mass lesions, with particular reference to its utility for the prediction of histological cell-type, Fuhrman nuclear grade and necrosis. Patients and methods: From May 1999 to September 2009, 71 patients underwent renal mass biopsy (RMB), most for indeterminate renal masses or in those with a mass lesion and extrarenal malignancy. Approximately one-third were for small renal masses (≤4cm). Biopsy results were correlated with final surgical specimen pathology or with the outcome of surveillance in those not receiving surgery. Results: Of 71 biopsies, there were 65 (91.5%) considered diagnostic biopsies, of which 59 (90.8%) were malignant and 6 (9.2%) were benign. 30 patients with biopsy-proven malignancy underwent extirpative surgery, with a diagnostic accuracy for biopsy of 100%. Accuracy of RMB for histological sub-type, Fuhrman nuclear grade and tumour necrosis was 80.0%, 52.3% and 80.0%, respectively. Bleeding complications were seen in 2 (2.8%) patients, and there were no cases of needle track seeding. Conclusion: RMB is a safe and accurate method for determining underlying malignancy, with an acceptable non-diagnostic rate. Although concordance for histological tumour sub-type and necrosis was reasonable, values for nuclear grade were less reliable.

scholarly journals The Natural History and Predictors for Intervention in Patients with Small Renal Mass Undergoing Active Surveillance

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Zaher Bahouth ◽  
Sarel Halachmi ◽  
Gil Meyer ◽  
Ofir Avitan ◽  
Boaz Moskovitz ◽  
...  
Keyword(s):  
Natural History ◽  
Active Surveillance ◽  
Renal Mass ◽  
Nephron Sparing Surgery ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing ◽  
The Mean

Aim. To describe the natural history of small renal mass on active surveillance and identify parameters that could help in predicting the need for intervention in patients with small renal masses undergoing active surveillance. We also discuss the need for renal biopsy in the management of these patients.Methods. A retrospective analysis of 78 renal masses ≤4 cm diagnosed at our Urology Department at Bnai Zion Medical Center between September 2003 and March 2012.Results. Seventy patients with 78 small renal masses were analyzed. The mean age at diagnosis was 68 years (47–89). The mean follow-up period was 34 months (12–112). In 54 of 78 masses there was a growth of at least 2 mm between imaging on last available follow-up and diagnosis. Eight of the 54 (15%) masses which grew in size underwent a nephron-sparing surgery, of which two were oncocytomas and six were renal cell carcinoma. Growth rate and mass diameter on diagnosis were significantly greater in the group of patients who underwent a surgery.Conclusions. Small renal masses might eventually be managed by active surveillance without compromising survival or surgical approach. All masses that were eventually excised underwent a nephron-sparing surgery. None of the patients developed metastases.

Partial nephrectomy in the setting of metastatic renal cell carcinoma.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 440-440
Author(s):  
Kara Babaian ◽  
Surena F. Matin ◽  
Pheroze Tamboli ◽  
Nizar M. Tannir ◽  
Eric Jonasch ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Renal Mass ◽  
Cytoreductive Nephrectomy ◽  
Cancer Specific Survival ◽  
Renal Masses

440 Background: Up to one-third of patients with renal cell carcinoma present with metastatic disease (mRCC). Cytoreductive nephrectomy remains the standard of care for appropriately selected patients. However, cytoreductive nephrectomy is not always practical. We sought to identify the indications and outcomes for partial nephrectomy (PN) in our cohort of patients with mRCC, with particular attention to different PN subgroups. Methods: Using our institutional database, 30 patients with mRCC who underwent PN between 1996 and 2011 were identified. Demographic, clinical, and pathologic variables were collected. Non-parametric statistics and log-rank tests were used. Cancer specific survival (CSS) was estimated using Kaplan-Meier method according to presentation, tumor size, and presence of metastatic disease, from the time of PN to last follow-up or death. Results: The median age at PN was 57 years (range 32-84). 8 patients presented with bilateral synchronous renal masses; 17 presented with a metachronous contralateral renal mass; and 5 presented with a unilateral renal mass (including 3 in a solitary kidney). Median follow-up after PN was 32 months (range 1-184). Overall, 23 patients (77%) died of disease at a median of 27 months (range 7-86) after PN. Patients who underwent PN for a metachronous contralateral renal mass had a median CSS of 61 months compared to those with bilateral synchronous or unilateral renal masses (CSS 26.5 months, HR 2.98, p =.012 and CSS 31, HR 2.12, p =.069, respectively). Patients who underwent PN for a renal mass ≤4cm and >4cm had a median CSS of 42 and 26.5 months, respectively (HR 2.49, p =.037). Median CSS for patients with and without metastatic disease at original diagnosis was 27 and 61 months, respectively (HR 2.85, p =.013). In this study, patients who became M0 after metastasectomy did not have improved CSS compared to patients who did not (42 and 32 months, p =0.152). Conclusions: Our findings suggest that the burden of disease at initial diagnosis, timing of presentation of the PN index lesion, and the size of the renal mass at PN play an important role in survival. These factors should be taken into consideration when determining which patients would benefit from PN in the setting of mRCC.

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