Role of Renal Mass Biopsy Flashcards
what is the definition of small renal masses?
<4cm
what percentage of SRM are benign
20%
what are management options for SRMs?
PNx, RNx, AS, thermal ablation, watchful waiting
Is biopsy of renal masses >4cm typically recommended?
Nope unless there is some compelling reason
When should renal mass biopsy be offered to patients?
when results would change management
How should a renal mass biopsy be done? what affects its accuracy>
2-3 core bx from the mass, DONT do FNA
accuracy is affected by hospital, mass size, mass location, patient factors
What are complications with renal mass biopsy?
bleeding, hematuria, back pain, blood transfusion, (risk of tumor seeding is extremely low)
Should renal mass biopsy be discussed with SRM prior to mgmt?
YES
Should you offer repeat biopsy to the patient if the first one was non-diagnostic?
YES, discuss with them at least
What should you do if a patient has benign histology?
still follow them and inform them of risk of false negative bx( 3.5% based on one Canadian series)
What malignant tumor does oncocytoma look like?
Chromophobe RCC. be warry of that if you get Oncocytoma on biopsy
Should you do a renal mass biopsy in an 85 year old with end stage CHF and MCRPC?
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.
Should you offer biopsy to a 40 year old anxious man who just wants the “tumor out”?
No, Renal mass biopsy should not be recommended to
patients who will want to proceed with definitive management irrespective of the biopsy result.
a 35 year old female has an incidentally found lesion with areas of HU -90, -100. would you offer biopsy?
NO, dont biopsy AMLs with classic radiographic appearance
Should you offer biopsy of cystic renal masses? if yes, which ones?
Yes, if they have a significant solid component that can be targeted, otherwise NO
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?
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).
Renal mass biopsy or biopsy of a metastatic lesion
should be considered to obtain a diagnosis in patients
with suspected metastatic RCC.
Correct
Should you obtain renal mass biopsy of SRM if RT or ablation is planned?
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.
