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Inicio Actas Urológicas Españolas (English Edition) Lessons learned from the comparative study between renal mass biopsy and the ana...
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Vol. 38. Issue 10.
Pages 655-661 (December 2014)
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Vol. 38. Issue 10.
Pages 655-661 (December 2014)
Original article
Lessons learned from the comparative study between renal mass biopsy and the analysis of the surgical specimen
Enseñanzas derivadas del estudio comparativo entre biopsia de masa renal y el análisis del espécimen quirúrgico
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M. Domínguez-Estebana,
Corresponding author
mariodominguezesteban@gmail.com

Corresponding author.
, F. Villacampa-Aubáb, H. Garcia-Muñózc, Á. Tejido Sánchezb, J. Romero Oterob, F. de la Rosa Kehrmannb
a Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Unidad de Uro-Oncología, Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, Spain
c Sección de Uro-Patología, Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
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Tables (6)
Table 1. Clinicopathologic variables: descriptive study of the renal mass and final pathology analysis.
Table 2. Clinicopathologic variables and their relation to the validity of the biopsy.
Table 3. Percentage of correct valid biopsies in relation to the final analysis of the piece.
Table 4. Errors in the histological diagnosis of both biopsies, with at least one valid.
Table 5. Clinicopathologic variables and their statistical relation with the diagnostic success of the histologic type and the tumor grade of the final piece.
Table 6. Results of the main current series evaluating renal mass biopsy.
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Abstract
Introduction

The role of renal mass (RM) biopsy is currently under discussion. As a result of the progressive increase in the incidental diagnosis of RMs (which have a higher percentage of benignity and well-differentiated cancers), new approaches have emerged such as observation, especially with elderly patients or those with significant comorbidity. RM biopsy (RMB) should provide sufficient information for making this decision, but so far this has not been the case. We examine our prospective series of in-bench RMBs after surgery and compare them with the anatomy of the removed specimen.

Material and methods

We obtained (prospectively, in-bench and with a 16-gauge needle) 4 biopsies of RMs operated on in our department from October 2008 to December 2009. These RMs were analyzed by 2 uropathologists and compared with the results of the specimen.

Results

We analyzed 188 biopsies (47 RMs); 12.75% were “not valid”. The ability of biopsy to diagnose malignancy or benignity was 100%, and the coincidence in the histological type was 95%. The success in determining the tumor grade was 100% when the cancer was low-grade and 62% when high-grade. None of the analyzed data (necrosis, size, etc.) influenced the results in a statistically significant manner.

Conclusion

RMB with a 16-G needle enables the differentiation between malignancy and benignity in 100% of cases, with a very similar diagnostic accuracy in the tumor type. Tumor grade is still the pending issue with renal mass biopsy.

Keywords:
Biopsy
Renal mass
Grade
Histology
Resumen
Introducción

El papel de la biopsia de masa renal (MR) está actualmente en discusión. Ante el aumento progresivo en el diagnóstico incidental de MR (que tienen un mayor porcentaje de benignidad y cánceres bien diferenciados) surgen nuevos planteamientos como la observación, especialmente en pacientes añosos o con importante comorbilidad. La biopsia de la MR (BMR) debería proporcionar datos suficientes para tomar esa decisión, pero hasta ahora no ha sido así. Estudiamos nuestra serie prospectiva de BMR tomadas en banco tras la cirugía, comparándola con la anatomía de la pieza extirpada.

Material y métodos

Se obtuvieron, prospectivamente y en banco, 4 biopsias con aguja 16 Gauge (G) de las MR operadas en nuestro servicio desde octubre de 2008 a diciembre de 2009. Estas fueron analizadas por 2 uropatólogos y comparadas con el resultado de la pieza.

Resultados

Se analizaron 188 biopsias (47 MR): 12,75% «no validas». La capacidad de la biopsia para diagnosticar la malignidad o benignidad fue del 100%, y la coincidencia en el tipo histológico del 95%. El acierto en el grado tumoral fue del 100% si el tumor era de bajo grado y del 62% si era de alto grado. Ninguno de los datos estudiados (necrosis, tamaño…) influyeron de manera estadísticamente significativa en los resultados.

Conclusión

La BMR con aguja 16G permite diferenciar entre malignidad y benignidad en 100% de los casos, con una exactitud diagnóstica en el tipo tumoral muy similar. El grado tumoral sigue siendo la asignatura pendiente de la BMR.

Palabras clave:
Biopsia
Masa renal
Grado
Histología

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