NEW ORLEANS, LA USA (UroToday.com) - Percutaneous renal biopsy (PRB) under real-time ultrasound guidance is a routine procedure performed to diagnose renal mass histopathology. The indications for PRB have expanded, as there has been a substantial increase in the number of small renal masses (SRM) that are being diagnosed, and the acceptance of pre-treatment biopsy for SRM continues to expand. Additionally, imaging technologies continue to improve with higher quality ultrasound devices routinely being introduced into clinical practice.
Due to the percent of incidental renal tumors and localized tumors increasing, management of small renal masses (SRM) (renal cortical tumors ≤ 4 cm) is a frequent clinical problem. By traditional treatment strategies, which were designed to treat larger renal masses, all SRMs were managed as if they were malignant. Typically, management included ablative, open radical, or extirpative surgery. With technological advancement, urologists have several treatment modalities now available for management of SRMs, ranging from active surveillance to ablative techniques.
Dr. Landman emphasized that according to the AUA guidelines, 24% of histopathological staging of removed tumors are indicated as benign, thus indicating that the surgery was unnecessary.
Biopsy can be performed with sedation, but it can be successfully performed under local anesthesia. Dr. Landman’s technique has been described in the recent articles published in British Journal of Urology. Generally, access is obtained under the 12th rib and a spinal needle is used to anesthetize the tract. He recommends to work with the patient. Since the patient is awake, you have him breath normally up until you’re ready to do the biopsy, then request to have him hold his breath. In his series of 62 biopsied patients, there was a 19% benign tumor rate from partials, and cryoablation was reduced to a staggering 1.6%, meaning 12 patients avoided surgery.
He demonstrated a new ultrasound probe that has been developed by Hitachi-Aloka, and was tested in his lab, using a gel model with an olive inserted. Retrieving a green-red-green pattern, from the olive and a pimento center, indicated a successful biopsy.
Dr. Landman concluded that while surgical excision is preferred and the superior treatment option for aggressive RCC subtypes, some histopathological subtypes are successfully managed with alternative treatment options. Knowledge of tumor histopathology on preoperative evaluation allows for a more selective treatment approach, avoiding unnecessary surgery, and minimizing the need for aggressive surgical procedures. These factors have stimulated surgeons to look for preoperative factors and techniques to evaluate tumor histopathology. In terms of cost, although no surgical approach was taken, there is a significant level of savings,
Presented by Jaime Landman at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
University of California, Irvine, CA USA
Reported by Victor Huynh (University of California-Irvine), medical writer for UroToday.com