Interest of percutaneous renal biopsy for small renal masses.

539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal masses. Methods: Retrospective analysis from 01/2007 to 12/2012 of percutaneous CT-scan guided renal biopsies performed at our institution for patients harboring renal tumors. Exclusion criteria were presence of metastasis and/or >4cm tumors. Data analyzed were pathological outcomes, management of the tumors and complications from the procedure during the 30 days post-biopsies. Results: 119 patients underwent a renal biopsy during this period. 79 presented the selection criteria. Renal biopsies lead to a diagnosis in 70 cases (88.6%) and were non contributive in 9 cases (11.4%). Among contributive biopsies, there were 46 (66%) cases of cancer and 24 cases (34%) of benign tumors. During follow-up, 2 (2.5%) patients presented Clavien-Dindo grade I-II complications: 1 acute urinary retention and 1 subfebrile lumbar pain. Conclusions: The yield of CT-scan guided renal biopsies to define pathological features of small renal masses was of 88.6%. Morbidity of the technique is low. We consider renal biopsy as a relevant strategy to diagnose a small renal mass, to define the best treatment and to prevent morbidity from useless invasive surgical procedures. [Table: see text]

Download Full-text

The Role of Surveillance in the Management of Small Renal Masses

The Scientific World JOURNAL ◽

10.1100/tsw.2007.157 ◽

2007 ◽

Vol 7 ◽

pp. 860-868 ◽

Cited By ~ 11

Author(s):

Alessandro Volpe

Keyword(s):

Natural History ◽

Active Treatment ◽

Initial Period ◽

Renal Tumors ◽

Small Renal Masses ◽

Renal Masses ◽

Cross Sectional ◽

Slow Growth Rate ◽

History Of

Incidentally detected, small renal masses (SRMs) have been increasing significantly in recent years due to the widespread use of improved cross-sectional imaging. A significant number of incidental SRMs are diagnosed in elderly patients who are more likely to undergo imaging for other medical issues. The natural history of SRMs has not been historically well understood because most masses are surgically removed soon after diagnosis.Several reports of surveillance of SRMs have been published in the last few years. When followed conservatively with serial imaging, SRMs have variable growth rates with an average of 0.28 cm/year, according to a recent meta-analysis. Larger series with longer follow-up are needed, but a significant number of small tumors seem to have an indolent behavior with a slow growth rate and a limited tendency to progress. The standard of care for enhancing SRMs is surgery. Up to one-third of surgically removed, <4-cm tumors are histologically benign. The outcomes of current surgical treatment of histologically confirmed, <4-cm, renal cell carcinomas are excellent, but this has not led to a decrease in mortality. Based on these considerations and on the available data on the natural history of SRMs, it seems reasonable to consider that we may be overtreating these lesions. This is especially true for elderly or unfit patients who have a decreased life expectancy. In these selected patients and in patients who refuse active treatment, it seems reasonable to propose an initial period of active surveillance for incidental SRMs, with delayed intervention for those tumors that will exhibit fast growth during follow-up. Percutaneous needle biopsies of renal tumors can be safely performed with the use of modern techniques and have the potential to characterize SRMs at histologically diagnosis, thereby allowing a better selection of the conservative or active treatment that is best suited for each individual patient.

Download Full-text

Management of Small Renal Masses

10.2310/tywc.11094 ◽

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

Download Full-text

Management of Small Renal Masses

10.2310/uro.11094 ◽

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

Download Full-text

Mini invasive approaches in the treatment of small renal masses: TC-guided renal cryoablation in elderly

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.4.309 ◽

2020 ◽

Vol 92 (4) ◽

Author(s):

Oscar Selvaggio ◽

Giovanni Silecchia ◽

Matteo Gravina ◽

Ugo Giovanni Falagario ◽

Giovanni Stallone ◽

...

Keyword(s):

The Elderly ◽

Local Relapse ◽

Lumbar Pain ◽

Complication Rates ◽

Small Renal Masses ◽

Renal Masses ◽

Ct Guided ◽

Definition Of ◽

Incomplete Treatment

Background: Today, the goal of surgery is to achieve oncological efficacy with the lowest complication rate. Computed Tomography (CT)-guided cryoablation is proposed as a safe and effective technique. We report, our series of small renal masses treated with cryoablation in elderly (> 70 years). Methods: From May 2014 to April 2019, 32 patients with median (IQR) age of 75.5 years (range 71-80) with small renal masses (< T1a) diagnosis, clinical anesthesia contraindications to nephron-sparing surgery or patient’s will previous informed consent have been selected at our Urology Department. All patients underwent CT-guided cryoablation, preceded by needle biopsy. The cryoablation consisted in a procedure with an argon/helium gas-based system under local anesthesia. The follow-up included CT abdomen at 3, 6 and 12 months. The definition of incomplete treatment was the persistence of the lesion contrast enhancement (CE) at the end of the scan; the definition of relapse was the appearance of the CE to the 6-month control CT.Results: The median follow-up was 30 months (IQR 1-59). The median size of the tumor was 3.85 cm (IQR 1.6-4.5). All patients underwent lesion biopsy resulting in diagnosis of Renal Cell Carcinoma (RCC) in 29 patients (90.7%) and oncocytoma in 3 patients (9.3%). A median of 2 cryoprobes (IQR 1- 3) was used and 2/3 cycles of freeze-thaw of the duration of 10 minutes or 5 minutes were performed. Complications were: 3 asymptomatic transitional perirenal effusion, 2 lumbar pain well-controlled by analgesic drug. Hospital stay was 2 days (range 1-3). No case showed incomplete treatment and local relapse or metastates at the CT abdomen-pelvis with contrast medium at 12 months. Conclusions: This study shows the efficacy and safety of percutaneous cryoablation of small renal masses in elderly population. The procedure is easy to perform, with low complication rates and well tolerated by the elderly patients.

Download Full-text

Reliability of the CT-SCAN percutaneous biopsy for small renal masses.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.514 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 514-514

Author(s):

Alexandre Ingels ◽

Eric Barret ◽

Francois Audenet ◽

Luca Lunelli ◽

Guilherme Prada Costa ◽

...

Keyword(s):

Ct Scan ◽

Renal Biopsy ◽

Renal Mass ◽

Biopsy Sample ◽

Renal Lesion ◽

Small Renal Mass ◽

Renal Masses ◽

Surgical Specimen ◽

Nephron Sparing ◽

Renal Biopsies

514 Background: The aim of this study was to assess the veracity of the outcomes from renal biopsy performed under CT-scan control for patients harboring cT1a stage tumors. Methods: In a retrospective study, we analyzed the outcomes of renal biopsies performed under CT-scan control for patients harboring tumors under 4 cm. Pathology has been compared between biopsy sample and nephrectomy specimen. Every patient included had a small renal mass (cT1a) and had to undergo a CT-scan guided renal biopsy before nephron sparing or enlarged nephrectomy (that had to be done within 6 months after the biopsy). Results: From January 2007 to December 2012, we performed 79 CT-scan guided renal biopsies. Among these patients, biopsy lead to the diagnosis of the renal lesion for 70 cases. For 9 cases, biopsy was not contributive. Following the biopsy, 19 patients underwent a nephron sparing surgery and 10 a radical nephrectomy. Comparison of the pathological outcomes between biopsy and surgical specimen showed an agreement for the diagnosis of carcinoma in 28 cases (97%): one case of chromophobe carcinoma on biopsy sample analyze happened to be an oncocytoma on the surgical specimen. Sensitivity was 100% and Specificity 67%. Conclusions: Renal biopsy under CT-scan control yield to a trustful diagnosis of small renal mass in most of the cases. It seems relevant to systematically offer this strategy to the patients in order to adapt their following treatment.

Download Full-text