scholarly journals Small Renal Mass Biopsy: When to Do?

2021 ◽  
Vol 19 (3) ◽  
pp. 129-135
Author(s):  
Jin Seon Cho
Keyword(s):  
Risk Stratification ◽  
Renal Mass ◽  
Treatment Options ◽  
Benign Tumors ◽  
Small Renal Mass ◽  
Tumor Biopsy ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Improve Risk Stratification ◽  
Cross Sectional Imaging

The incidence of small renal mass (SRM) is increasing largely owing to the growing use of cross-sectional imaging. About 20% of SRMs are benign, and smaller masses are likely to have pathological characteristics of low malignant potential. Determining the optimal management for SRM can be challenging. Advances in our understanding of the nature of SRMs and expanding treatment options for SRMs have stimulated interest in SRM biopsy which can facilitate risk stratification and prognostication. Continuing concern regarding complications and accuracy, SRM biopsy is underutilized. However, recent series on SRM biopsy have reported diagnostic accuracy and rare complications. The median concordance rate between tumor histotype on renal tumor biopsy and on the surgical specimen was over 90%. SRM biopsy can be selectively used to improve risk stratification in patient where the clinical management may change on the basis of the results of biopsy. Currently, SRM biopsy can be recommended in most cases except in patients who have imaging or clinical characteristics indicative of benign tumors and in cases in which conservative management is considered. Urologists should be aware of the benefits of SRM biopsy which should be discussed with patients.

scholarly journals The Past, Present, and Future in Management of Small Renal Masses

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sarah C. Ha ◽  
Haley A. Zlomke ◽  
Nicholas Cost ◽  
Shandra Wilson
Keyword(s):  
Renal Mass ◽  
Treatment Modalities ◽  
Small Renal Mass ◽  
Consensus Guidelines ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
The Past ◽  
Cross Sectional Imaging ◽  
Ablative Techniques

Management of small renal masses (SRMs) is currently evolving due to the increased incidence given the ubiquity of cross-sectional imaging. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. New consensus guidelines and treatment modalities are changing frequently. The multitude of information currently available shall be summarized in this review. This summary will detail the historic surgical treatment of renal cell carcinoma with current innovations, the feasibility and utility of biopsy, the efficacy of ablative techniques, active surveillance, and use of biomarkers. We evaluate how technology may be used in approaching the small renal mass in order to decrease morbidity, while keeping rates of overtreatment to a minimum.

scholarly journals Malignant Mesenchymal Renal Tumor: A Rare Case of Primary Renal Fibrosarcoma

2013 ◽  
Vol 3 ◽  
pp. 52 ◽  
Author(s):  
Madanmohan Gupta ◽  
Nandini U. Bahri ◽  
Pankaj Watal ◽  
Shilpa L. Chudasama ◽  
Swetang G. Brahmbhatt ◽  
...  
Keyword(s):  
Rare Case ◽  
Renal Mass ◽  
Renal Tumor ◽  
Abdominal Discomfort ◽  
Renal Neoplasms ◽  
Cross Sectional ◽  
Elderly Female ◽  
Mesenchymal Neoplasms ◽  
Cross Sectional Imaging ◽  
Rare Group

Malignant mesenchymal neoplasms of kidney constitute a rare group of tumors. Primary fibrosarcoma of kidney is an extremely rare subtype of primary malignant mesenchymal renal neoplasms. An elderly female presented with a gradually increasing abdominal lump and mild abdominal discomfort. On cross-sectional imaging, the lesion showed features suggestive of an atypical renal mass not conforming to either ball or bean type growth pattern. The mass was surgically removed and on histopathological and immunohistological investigations diagnosed to be primary renal fibrosarcoma.

Utilization of imaging in pancreatic adenocarcinoma patients status post Whipple procedure.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16725-e16725
Author(s):  
Neal Shah ◽  
Ruchika Podury ◽  
Elias Kikano ◽  
Daniel Arnold Smith ◽  
Nikhil H. Ramaiya ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Whipple Procedure ◽  
Stage I ◽  
Western World ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Female Ratio ◽  
Cross Sectional Imaging ◽  
Imaging Utilization ◽  
Male To Female

e16725 Background: Pancreatic adenocarcinoma (PAC) remains the third leading cause of cancer death in the Western world. The 5-year survival of patients with PAC remains at 4%. Proper utilization of imaging to detect recurrence is necessary in patients who have undergone a Whipple procedure. Currently, Carbohydrate (CA) 19-9 is used for screening and is the only biomarker approved by the Food and Drug Administration (FDA). Sensitivity and specificity range from 79-81% and 82-90%. We intend to evaluate our single institute experience of imaging utilization, CA 19-9, and surgical specimen histopathologic features in the surveillance of PAC patients status post Whipple. Methods: Retrospective analysis of patients with a diagnosis of PAC who underwent imaging status post Whipple from 2008 - 2018 was completed. Cross-sectional imaging and clinical data was obtained from the electronic health record. Results: A total of 197 PAC patients status post Whipple were identified with mean age at diagnosis at 64.4 years and male to female ratio of 1.3. 85 patients were found to have died during treatment. The median survival for these patients was 68 years. Of the patients who died status post Whipple, postoperative CA 19-9 levels within 6 months of the procedure were elevated (p = 0.01). Patients who were found to have stage II to IV PAC at diagnosis were found to have a high CA 19-9 level within 6 months post-Whipple when compared to stage I patients (p < 0.05). Patients who were found to have less than 5 surveillance CTs status post Whipple were found to have higher CA 19-9 levels within 6 months status post Whipple (p < 0.01). There was no difference in number of CT scans between stages. Of those patients who died with stage I or II PAC at diagnosis, a large number were found to have less than 5 surveillance CT studies completed status post Whipple (p < 0.05). Furthermore, a higher cancer stage at diagnosis correlated with worse pathologic differentiation of the cancer (p < 0.001). Conclusions: Post Whipple CA 19-9 correlated with stage, recurrence, number of scans, and survival.

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

Endoscopic Ultrasound Features Associated with Malignancy and Aggressiveness of Nonhypovascular Solid Pancreatic Lesions: Results from a Prospective Observational Study

2019 ◽  
Author(s):  
Stefano Francesco Crinó ◽  
Alessandro Brandolese ◽  
Filippo Vieceli ◽  
Salvatore Paiella ◽  
Maria Cristina Conti Bellocchi ◽  
...  
Keyword(s):  
Observational Study ◽  
Lymph Nodes ◽  
Endoscopic Ultrasound ◽  
Prospective Observational Study ◽  
Distant Metastases ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Tissue Acquisition

Abstract Background and Study Aims On contrast-enhanced imaging studies, nonhypovascular (i. e., isovascular and hypervascular) patterns can be observed in solid pancreatic lesions (SPLs) of different nature, prognosis, and management. We aimed to identify endoscopic ultrasound (EUS) features of nonhypovascular SPLs associated with malignancy/aggressiveness. The secondary aims were EUS tissue acquisition (EUS-TA) outcome and safety in this setting of patients. Patients and Methods This prospective observational study included patients with nonhypovascular SPLs detected on cross-sectional imaging and referred for EUS-TA. Lesion features (size, site, margins, echotexture, vascular pattern, and upstream dilation of the main pancreatic duct) were recorded. Malignancy/aggressiveness was determined by evidence of carcinoma at biopsy/surgical pathology, signs of aggressiveness (perineural invasion, lymphovascular invasion, and/or microscopic tumor extension/infiltration or evidence of metastatic lymph nodes) in the surgical specimen, radiologic detection of lymph nodes or distant metastases, and/or tumor growth > 5 mm/6 months. Uni- and multivariate analyses were performed to assess the primary aim. Results A total of 154 patients with 161 SPLs were enrolled. 40 (24.8 %) lesions were defined as malignant/aggressive. Irregular margins and size > 20 mm were independent factors associated with malignancy/aggressiveness (p < 0.001, OR = 5.2 and p = 0.003, OR = 2.1, respectively). However, size > 20 mm was not significant in the subgroup of other-than-neuroendocrine tumor (NET) lesions. The EUS-TA accuracy was 92 %, and the rate of adverse events was 4 %. Conclusion Irregular margins on EUS are associated with malignancy/aggressiveness of nonhypovascular SPLs. Size > 20 mm should be considered a malignancy-related feature only in NET patients. EUS-TA is safe and highly accurate for differential diagnosis in this group of patients.

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

scholarly journals EUS is accurate in characterizing pancreatic cystic lesions; a prospective comparison with cross-sectional imaging in resected cases

2020 ◽  
Author(s):  
Sahar Wesali ◽  
Mehmet A. Demir ◽  
Caroline S. Verbeke ◽  
Mats Andersson ◽  
Svein Olav Bratlie ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Cystic Lesions ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Surgical Specimen ◽  
Prospective Comparison ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Abstract Background Imaging modalities for characterizing pancreatic cystic lesions (PCLs) is a known uncertainty. The aim of this prospective study was to compare the diagnostic performance of endoscopic ultrasound morphology, cytology and cyst fluid carcinoembryonic antigen (EUS-FNA-CEA) with cross-sectional imaging in resected PCLs. Methods The cross-sectional imaging and EUS-FNA-CEA results were collected in an academic tertiary referral centre using histology of the surgical specimen as the diagnostic standard. Results Of 289 patients undergoing evaluation for PCL with cross-sectional imaging and EUS-FNA between February 2007 and March 2017, 58 underwent surgical resection providing a final diagnosis of the PCLs: 45 mucinous, 5 serous, 1 pseudocyst, 2 endocrine, 2 solid pseudopapillary neoplasms and 3 other. EUS-FNA-CEA was more accurate than cross-sectional imaging in diagnosing mucinous PCLs (95% vs. 83%, p = 0.04). Ninety-two percent of the PCLs with high-grade dysplasia or adenocarcinoma were smaller than 3 cm in diameter. The sensitivity of EUS-FNA-CEA and cross-sectional imaging for detecting PCLs with high-grade dysplasia or adenocarcinoma were 33% and 5% (p = 0.03), respectively. However, there was no difference in accuracy between the modalities (62% vs. 66%, p = 0.79). The sensitivity for detecting pancreatic adenocarcinomas only was 64% for EUS-FNA-CEA and 9% for cross-sectional imaging (p = 0.03). Overall, EUS-FNA-CEA provided a correct diagnosis in more patients with PCLs than cross-sectional imaging (72% vs. 50%, p = 0.01). Conclusions EUS-FNA-CEA is accurate and should be considered a complementary test in the diagnosis of PCLs. However, the detection of PCLs with high-grade dysplasia or adenocarcinoma needs to be improved. Cyst size does not seem to be a reliable predictor of high-grade dysplasia or adenocarcinoma.

Approach to the small renal mass: Weighing treatment options

2009 ◽  
Vol 10 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Brian M. Benway ◽  
Sam B. Bhayani
Keyword(s):  
Renal Mass ◽  
Treatment Options ◽  
Small Renal Mass

scholarly journals Retrorectal tumors: report of two cases

2013 ◽  
Vol 8 (4) ◽  
pp. 46-50
Author(s):  
P Kafle ◽  
CR Praveen ◽  
S Kumar ◽  
BN Patowary ◽  
N Maharjan ◽  
...  
Keyword(s):  
Young Women ◽  
Extent Of Resection ◽  
Benign Tumors ◽  
Surgical Removal ◽  
Medical Sciences ◽  
Retrorectal Tumor ◽  
Cross Sectional ◽  
Retrorectal Tumors ◽  
Cross Sectional Imaging ◽  
Nonspecific Sign

Retrorectal tumor is uncommon identity presenting with nonspecific sign and symptoms making difficulty in diagnosis. Benign tumors are more common than malignant. The lesion may be malignant or progress to malignancy from benign state. Retrorectal masses in young women may continue to grow and result in dystocia. Cystic lesions are also at risk of becoming infected, which renders subsequent excision more difficult and increase the risk of recurrence. Cross-sectional imaging is required to determine the extent of resection and the appropriate surgical approach. Surgical removal leads to favorable outcomes for patients with benign purely cystic retrorectal tumors. We report two such benign rectal lesions. ] Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 46-50 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8701  

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

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.

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