AUA 2018: Office-Based Ultrasound-Guided Percutaneous Renal Mass Biopsy

San Francisco, CA USA ( Cyrus Lin, MD from the University of California, Irvine (UCI), presented data on the feasibility, safety, and efficacy of office-based, ultrasound-guided percutaneous renal biopsy. As an introduction to his talk, Lin explained that the recent rise of imaging-driven incidences of small renal cortical neoplasms has created an interest in a “biopsy before treatment” approach. In this multicenter study, Lin and team prospectively evaluated the efficacy of urologist performed, office based, ultrasound guided, percutaneous renal biopsy (USPRB).

Three institutions took part in this study: The University of California, Irvine, John Hopkins, and the Smith Institute of Urology. A total of 71 patients with non-hilar RCN, without overlying bowel, liver, or spleen were recruited for this study and received office-based USPRB. The procedures were performed in the prone position with a Hitachi-Aloka alpha 7 ultrasound with biopsy probe. After injection of 1% lidocaine, an 18G biopsy needle was inserted through the needle guide on the biopsy probe and 3-5 cores were taken. All patients were asked their pain level from 0 (no pain) to 10 (severe pain) before, right after, one hour after, and at their follow up appointment.

Following data analysis, Lin and team found that of the 71 patients, 59 had a definitive diagnosis after the first office-based biopsy. For the remaining 12 with non-diagnostic biopsies, 8 chose to undergo a repeat CT guided biopsy and 7 had a definitive diagnosis after. For all patients, median pain score (0-10) before the procedure was 0, during the procedure was 1 (0-3), an hour after the procedure was 0 (0-5), and at follow up was 0. Additionally, only one Clavien-1 self-resolving complication (hematuria) was reported during the study.

Cyrus Lin concluded that urologist performed, office based, ultrasound guided biopsy provided a definitive diagnosis of 83% with one biopsy. He added that with a secondary CT guided IR driven biopsy, the diagnostic rate increased to 98.5%. Lastly, he stated that a biopsy driven approach precluded surgical intervention in 38% of patients.

Presented by: Cyrus Lin, MD

Written by: Renai Yoon, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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