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6 - The case for biopsy in the modern management of renal cancer

Published online by Cambridge University Press:  08 August 2009

By
Colin P. Cantwell ,
Debra Gervais  and
Peter R. Mueller
Edited by
Uday Patel
Colin P. Cantwell
Affiliation:
Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
Debra Gervais
Affiliation:
Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
Peter R. Mueller
Affiliation:
Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
Uday Patel
Affiliation:
St George's Hospital, London
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Summary

Introduction

In the past, focal renal biopsy had a limited role in the management of renal masses. Potential complications and an overestimated risk of seeding the biopsy tract dissuaded operators from biopsy, and when performed definitive results were uncommon. Hence, urologists presumed that solid renal lesions over 3 cm and complex cysts were predominantly renal cell carcinomas (RCC) and rarely performed biopsy before surgical procedures.

Attitudes have changed to renal biopsy for a number of reasons, firstly, histological techniques have become more reliable. The morphology, immunocytochemical, and genetic profiles of RCC and its subtypes have been better described. Immunohistochemistry and special stains and genetic test are available to help differentiate tumor subtypes. Oncocytoma, oncocytic cancers, RCC and fat poor angiomyolipomas (AML) can now be differentiated histologically. There has also been a downward-stage migration of renal tumors at diagnosis and a substantial fraction of contemporary solid renal masses are benign. In one study, 12.8% of solid renal masses were found to be benign. When stratified by size, the proportion of benign masses was 25% for masses smaller than 3 cm, 30% for masses smaller than 2 cm, and 44% for masses smaller than 1 cm. Furthermore, small solid benign renal masses cannot be reliably distinguished from malignant masses by means of imaging findings alone.

Type
Chapter
Information
Carcinoma of the Kidney , pp. 112 - 125
Publisher: Cambridge University Press
Print publication year: 2007

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  • The case for biopsy in the modern management of renal cancer
    • By Colin P. Cantwell, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Debra Gervais, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Peter R. Mueller, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
  • Edited by Uday Patel, St George's Hospital, London
  • Book: Carcinoma of the Kidney
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545436.008
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  • The case for biopsy in the modern management of renal cancer
    • By Colin P. Cantwell, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Debra Gervais, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Peter R. Mueller, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
  • Edited by Uday Patel, St George's Hospital, London
  • Book: Carcinoma of the Kidney
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545436.008
Available formats
×

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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • The case for biopsy in the modern management of renal cancer
    • By Colin P. Cantwell, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Debra Gervais, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA, Peter R. Mueller, Division of Abdominal Imaging and Interventional Radiology, Department of Radiology and Harvard Medical School, Massachusetts, General Hospital, Boston, USA
  • Edited by Uday Patel, St George's Hospital, London
  • Book: Carcinoma of the Kidney
  • Online publication: 08 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545436.008
Available formats
×