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