AUA 2019: Office-Based, Ultrasound-Guided Renal Mass Biopsy: Technique and Results

Chicago, IL ( Most urologists forgo biopsy of renal masses prior to definitive therapy with surgical excision; however, over 20% of renal masses that are 4cm or smaller are benign. This results in thousands of unnecessary surgeries each year for patients who could be safely managed with active surveillance of their renal mass. Urologists at the University of California, Irvine have adopted a biopsy-first approach for many of their patients with renal masses. They presented a video demonstrating their technique for office-based, ultrasound-guided renal mass biopsy, followed by a presentation of their results using this modality.

Prior to performing the biopsy, the urologist uses only local anesthetic. The urologist then identifies the tumor on ultrasound. Next, using a specialized ultrasound probe with a built-in needle guide and on-screen needle tracking, the surgeon uses a standard biopsy gun to obtain 3-4 cores from the mass. The patient is then able to return to routine activities on the same day as the biopsy. 

After performing office-based biopsy in 52 patients, the UC Irvine group reported a diagnostic rate of 73% and a concordance with final pathology of 100% for primary histology (93% for renal cell carcinoma subtype and 90% for low vs. high Fuhrman grade). Of particular interest, 39% of patients were able to safely opt for active surveillance rather than surgery based on their biopsy results, and no patients with benign pathology on biopsy underwent surgery.

While renal mass biopsy remains a relatively controversial topic, these findings support the growing body of literature that indicates renal mass biopsy is safe, accurate, and can indeed change management strategies. 

Presented by: Francis Jefferson, MD, Department of Urology, University of California-Irvine
Co-authors: Zhamshid Okhunov, John M. Sung, Courtney M. Cottone, Roshan M. Patel, Jaime Landman, The University of California, Irvine

Written by: Francis Jefferson, Department of Urology, University of California-Irvine) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois