Renal Cell Carcinoma - Work-up
RENAL BIOPSY
RISK OF SEEDING
A recent renal mass biopsy (RMB) study of 24,548 patients found upstaging to pT3a perinephric fat involvement occurred in 1.2% of patients with 1.1% in the no biopsy group compared with 2.1% in patients who underwent RMB (P < 0.01). In multivariable logistic model, RMB was associated with pT3a perinephric fat upstaging (OR 1.69, 95% CI 1.17–2.44, P < 0.01). (2)
RISKS OF PROCEDURE
The biggest risk is nondiagnostic result, which occurs in 10-22% in large series of solid tumors and can increase to 40% for cystic masses. A large study of >1000 patients at U Wisconsin published in 2019 found a complication rate of 2.2% with 0.4% Clavien 3a or greater which parallels the 3% or less complciation rate of several larger studies. This study also found no relation to aspirin use (38% were on aspirin) , mild elevated INR up to 2, platelets as low as 25,000. (3)
IN OFFICE BIOPSY
In office biopsy has been shown to be safe and efficacious. (5)
A recent renal mass biopsy (RMB) study of 24,548 patients found upstaging to pT3a perinephric fat involvement occurred in 1.2% of patients with 1.1% in the no biopsy group compared with 2.1% in patients who underwent RMB (P < 0.01). In multivariable logistic model, RMB was associated with pT3a perinephric fat upstaging (OR 1.69, 95% CI 1.17–2.44, P < 0.01). (2)
RISKS OF PROCEDURE
The biggest risk is nondiagnostic result, which occurs in 10-22% in large series of solid tumors and can increase to 40% for cystic masses. A large study of >1000 patients at U Wisconsin published in 2019 found a complication rate of 2.2% with 0.4% Clavien 3a or greater which parallels the 3% or less complciation rate of several larger studies. This study also found no relation to aspirin use (38% were on aspirin) , mild elevated INR up to 2, platelets as low as 25,000. (3)
IN OFFICE BIOPSY
In office biopsy has been shown to be safe and efficacious. (5)
IMAGING
As of 2017, NCCN recommends chest CT if suspicious CXR. AUA proposes chest imaging without further details and EAU recommends use of chest CT for staging. Other authors have suggested using CT chest for cT1b disease or higher, cN1 disease or presence of systemic symptoms (1).
CYSTS
See Renal Cysts
MRI
MRI is more conclusive than CT at differentiating renal AML from RCC. (4)
CYSTS
See Renal Cysts
MRI
MRI is more conclusive than CT at differentiating renal AML from RCC. (4)
- Larcher, Alessandro, et al. "When to perform preoperative chest computed tomography for renal cancer staging." Bju international120.4 (2017): 490-496.
- Salmasi, Amirali, et al. "Association between renal mass biopsy and upstaging to perinephric fat involvement in a contemporary cohort of patients with clinical T1a renal cell carcinoma." Urologic Oncology: Seminars and Original Investigations. Elsevier, 2018.
- Posielski, N. M., Bui, A., Wells, S. A., Best, S. L., Gettle, L. M., Ziemlewicz, T. J., … Allen, G. O. (2019). Risk Factors for Complications and Nondiagnostic Results following 1,155 Consecutive Percutaneous Core Renal Mass Biopsies. The Journal of Urology, 201(6), 1080–1087.
- Nelson, Caleb P., and Martin G. Sanda. “Contemporary Diagnosis and Management of Renal Angiomyolipoma.” The Journal of Urology, vol. 168, no. 4, 2002, pp. 1315–1325.
- Dave, Chirag N., et al. "Office-based ultrasound-guided renal core biopsy is safe and efficacious in the management of small renal masses." Urology 102 (2017): 26-30.