Role of Renal Mass Biopsy

Question 1

what is the definition of small renal masses?

Answer 1

<4cm

Question 2

what percentage of SRM are benign

Answer 2

20%

Question 3

what are management options for SRMs?

Answer 3

PNx, RNx, AS, thermal ablation, watchful waiting

Question 4

Is biopsy of renal masses >4cm typically recommended?

Answer 4

Nope unless there is some compelling reason

Question 5

When should renal mass biopsy be offered to patients?

Answer 5

when results would change management

Question 6

How should a renal mass biopsy be done? what affects its accuracy>

Answer 6

2-3 core bx from the mass, DONT do FNA

accuracy is affected by hospital, mass size, mass location, patient factors

Question 7

What are complications with renal mass biopsy?

Answer 7

bleeding, hematuria, back pain, blood transfusion, (risk of tumor seeding is extremely low)

Question 8

Should renal mass biopsy be discussed with SRM prior to mgmt?

Answer 8

YES

Question 9

Should you offer repeat biopsy to the patient if the first one was non-diagnostic?

Answer 9

YES, discuss with them at least

Question 10

What should you do if a patient has benign histology?

Answer 10

still follow them and inform them of risk of false negative bx( 3.5% based on one Canadian series)

Question 11

What malignant tumor does oncocytoma look like?

Answer 11

Chromophobe RCC. be warry of that if you get Oncocytoma on biopsy

Question 12

Should you do a renal mass biopsy in an 85 year old with end stage CHF and MCRPC?

Answer 12

NO, Renal mass biopsy should not be recommended to
patients in whom active surveillance or watchful waiting will be recommended irrespective of the biopsy
result because of competing risks.

Question 13

Should you offer biopsy to a 40 year old anxious man who just wants the “tumor out”?

Answer 13

No, Renal mass biopsy should not be recommended to

patients who will want to proceed with definitive management irrespective of the biopsy result.

Question 14

a 35 year old female has an incidentally found lesion with areas of HU -90, -100. would you offer biopsy?

Answer 14

NO, dont biopsy AMLs with classic radiographic appearance

Question 15

Should you offer biopsy of cystic renal masses? if yes, which ones?

Answer 15

Yes, if they have a significant solid component that can be targeted, otherwise NO

Question 16

66 year old man with infiltrative 3 cm renal mass and

contiguous bulky retroperitoneal LNs. He also had lymphoma 6 years ago. would you offer a renal biopsy?

Answer 16

Yes consider a biopsy. Renal mass biopsy should be performed when a pathology
other than RCC is suspected for a mass that may
require management (e.g., lymphoma, metastatic lesion).

Question 17

Renal mass biopsy or biopsy of a metastatic lesion
should be considered to obtain a diagnosis in patients
with suspected metastatic RCC.

Answer 17

Correct

Question 18

Should you obtain renal mass biopsy of SRM if RT or ablation is planned?

Answer 18

Not necessarily. prior is better as you can give counselling. BUT Renal mass biopsy should be performed prior to, or at
the time of, thermal ablation or radiotherapy of the mass.