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01-01-2018 | Interventional

CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

Authors: Toshihiro Iguchi, Takao Hiraki, Yusuke Matsui, Hiroyasu Fujiwara, Jun Sakurai, Yoshihisa Masaoka, Hideo Gobara, Susumu Kanazawa

Published in: European Radiology | Issue 1/2018

Abstract

Objectives

To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy.

Methods

Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9–8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure.

Results

After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362–10.326; P = 0.011) to be a significant risk factor for diagnostic failure.

Conclusion

CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure.

Key points

• CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield.

• CT fluoroscopy-guided renal tumour biopsy is safe.

• Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

Thompson RH, Atwel T, Schmit G et al (2015) Comparison of partial nephrectomy and percutaneous ablation for cT1 renal cell masses. Eur Urol 67:252–259

Remzi M, Katzenbeisser D, Waldert M et al (2007) Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 99:1002–1006CrossRefPubMed

Volpe A, Mattar K, Finelli A et al (2008) Contemporary results of percutaneous biopsy of 100 small renal masses: a single center experience. J Urol 180:2333–23337CrossRefPubMed

Leveridge MJ, Finelli A, Kachura JR et al (2011) Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 60:578–584CrossRefPubMed

Maturen KE, Nghiem HV, Caoili EM, Higgins EG, Wolf JS Jr, Wood DP Jr (2007) Renal mass core biopsy: accuracy and impact on clinical management. AJR Am J Roentgenol 188:563–570CrossRefPubMed

Shannon BA, Cohen RJ, de Bruto H, Davies RJ (2008) The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses. J Urol 180:1257–1261CrossRefPubMed

Veltri A, Garetto I, Tosetti I et al (2011) Diagnostic accuracy and clinical impact of imaging-guided needle biopsy of renal masses. Retrospective analysis on 150 cases. Eur Radiol 21:393–401CrossRefPubMed

Wang R, Wolf JS Jr, Wood DP Jr, Higgins EJ, Hafez KS (2009) Accuracy of percutaneous core biopsy in management of small renal masses. Urology 73:586–590CrossRefPubMed

Katada K, Kato R, Anno H et al (1996) Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 200:851–856CrossRefPubMed

10.

Daly B, Templeton PA (1999) Real-time CT fluoroscopy: evolution of an interventional tool. Radiology 211:309–315CrossRefPubMed

11.

Carlson SK, Bender CE, Classic KL et al (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219:515–520CrossRefPubMed

12.

Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617CrossRefPubMed

13.

Yamagami T, Iida S, Kato T, Tanaka O, Nishimura T (2003) Combining fine-needle aspiration and core biopsy under CT fluoroscopy guidance: a better way to treat patients with lung nodules? AJR Am J Roentgenol 180:811–815CrossRefPubMed

14.

Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2003) Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 226:417–424CrossRefPubMed

15.

Iguchi T, Hiraki T, Gobara H et al (2017) Value of percutaneous needle biopsy of small renal tumors in patients referred for cryoablation. Minim Invasive Ther Allied Technol 26:86–91CrossRefPubMed

16.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

17.

Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C (2004) Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 171:1802–1805CrossRefPubMed

18.

Schmidbauer J, Remzi M, Memarsadeghi M et al (2008) Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. Eur Urol 53:1003–1011CrossRefPubMed

19.

Lebret T, Poulain JE, Molinie V et al (2007) Percutaneous core biopsy for renal masses: indications, accuracy and results. J Urol 178:1184–1188CrossRefPubMed

20.

Park SY, Park BK, Kim CK, Kwon GY (2013) Ultrasound guided core biopsy of small renal masses: diagnostic rate and limitations. J Vasc Interv Radiol 24:90–96CrossRefPubMed

21.

Aribas¸ BK, Arda K, Aktas E et al (2011) Percutaneous US-guided needle biopsies of solid renal masses. Neoplasma 58:146–152CrossRefPubMed

22.

Breda A, Treat EG, Haft-Candell L et al (2010) Comparison of accuracy of 14-, 18- and 20-G needles in ex-vivo renal mass biopsy: a prospective, blinded study. BJU Int 105:940–945CrossRefPubMed

23.

Hobbs DJ, Zhou M, Campbell SC, Aydin H, Weight CJ, Lane BR (2013) The impact of location and number of cores on the diagnostic accuracy of renal mass biopsy: an ex vivo study. World J Urol 31:1159–1164CrossRefPubMed

24.

Tsivian M, Rampersaud EN Jr, del Pilar Laguna Pes M et al (2014) Small renal mass biopsy-how, what and when: report from an international consensus panel. BJU Int 113:854–863CrossRefPubMed

25.

Volpe A, Kachura JR, Geddie WR et al (2007) Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 178:379–386CrossRefPubMed

26.

Ralls PW, Barakos JA, Kaptein EM et al (1987) Renal biopsy-related hemorrhage: frequency and comparison of CT and sonography. J Comput Assist Tomogr 11:1031–1034CrossRefPubMed

27.

Volpe A, Finelli A, Gill IS et al (2012) Rationale for percutaneous biopsy and histologic characterisation of renal tumours. Eur Urol 62:491–504CrossRefPubMed

28.

Szolar DH, Kammerhuber F, Altziebler S et al (1997) Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (<3-cm) renal masses. Radiology 202:211–217CrossRefPubMed

29.

Matsui Y, Hiraki T, Gobara H et al (2016) Radiation exposure of interventional radiologists during computed tomography fluoroscopy-guided renal cryoablation and lung radiofrequency ablation: direct measurement in a clinical setting. Cardiovasc Intervent Radiol 39:894–901CrossRefPubMed

30.

Kim GR, Hur J, Lee SM et al (2011) CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 21:232–239CrossRefPubMed

Title: CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure
Authors: Toshihiro Iguchi
Takao Hiraki
Yusuke Matsui
Hiroyasu Fujiwara
Jun Sakurai
Yoshihisa Masaoka
Hideo Gobara
Susumu Kanazawa
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4969-7

At a glance: The STEP trials

Springer Medicine

CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

Abstract

Objectives

Methods

Results

Conclusion

Key points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key points

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