(Ultrasound Review) Radiologists from the University of Michigan Medical Center in Ann Arbor conducted a retrospective study of ultrasound-guided core biopsies of renal masses in order to determine the usefulness of the procedure.
The authors commented that ultrasound-guided biopsy in this group of patients was underutilized due to a perceived lack of "safety, reliability and accuracy." The American Journal of Roentgenology published their findings.
Twenty-six patients had two to five cores obtained using an 18-gauge automatic biopsy gun. Seventy-three percent of masses were malignant and 27% were benign. Core biopsy enabled a specific diagnosis in 92% of renal masses.
"All biopsy specimens in our study were sufficient for analysis, and repeated biopsies were not performed. This technique showed a sensitivity and a specificity of 100% for the diagnosis of malignancy," they said.
According to the authors, "the sonographically guided core biopsy established a specific diagnosis in 95% (18/19) of the malignant masses in our series. Metastases and lymphomas were easily distinguished from renal cell carcinomas." Ultrasound-guided biopsy correctly diagnosed 86% of the benign masses, and a nonrepresentative specimen was thought to be the cause of one incorrect case.
A number of researchers have described hemorrhage as a common complication following renal biopsy, and hemorrhage occurred in 19% of patients in this study. A literature search revealed six incidents of needle track seeding associated with renal biopsies involving primarily renal cell carcinoma and uroepithelial malignancies. None of the cases in this study had developed tumor seeding. Other potential complications include postprocedural renal artery pseudoaneurysm arteriovenous fistula formation, and their one case of peritoneal bleeding required arterial embolization.
The authors concluded, "sonographically-guided percutaneous core biopsy is a safe procedure that can be performed in an outpatient setting. It is an effective method for establishing the presence of malignancy and a definitive diagnosis.’
Evaluation of sonographically guided percutaneous core biopsy of renal massesE M Caoili et al
Department of radiology, University of Michigan Medical Center, Ann Arbor, MI AJR 2002; 179:373-378
By Ultrasound Review
August 22, 2002
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