SAN FRANCISCO, CA USA (UroToday.com) - Dr. Marc Smaldone presented an overview of the role and reliability of renal mass biopsy given the heterogeneity of renal tumors.
Historically there were concerns about sampling error, low negative predictive value, technical failure, procedure-related complications, and biopsy tract seeding. However, modern renal mass biopsy is safe, and accuracy rates greater than 90%, with sensitivities and specificities ranging from 80-92% and 83-100%, respectively, having been reported. The use of renal mass biopsy has increased in the modern era, primarily to identify patients who harbor benign lesions and for whom treatment may be avoided, such as the frail and elderly.
False negative biopsy rates in contemporary series are < 5%, and repeat biopsy in non-diagnostic cases has accuracy rates > 80%. Tumor tract seeding, long a feared complication of renal mass biopsy, has a reported incidence of < 0.01%. The largest modern clinical limitation of renal mass biopsy is the inability to differentiate low- from high-risk malignancy by tumor grade. Using core biopsy rather than fine needle aspiration has improved accuracy of renal mass biopsy.
The ability of renal mass biopsy to predict tumor phenotype is uncertain, and recent data illustrate that genomic analyses underestimate the mutational burden of heterogeneous tumors. Improvement in the ability of renal mass biopsy to accurately predict tumor phenotype could impact development of personalized treatment strategies for kidney cancer. As renal mass biopsy has improved, the role of biopsy to help guide individualized therapy has become more clearly defined. In the future, molecular information from renal mass biopsy specimens will be integrated into clinical algorithms to guide patient counseling and inform personalized decision-making.
Highlights of a presentation by Marc C. Smaldone, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA