Volpe Alessandro, Mattar Kamal, Finelli Antonio, Kachura John R, Evans Andrew J, Geddie William R, Jewett Michael A S
Department of Surgical Oncology, Division of Urology, Medical Imaging, Princess Margaret Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2008 Dec;180(6):2333-7. doi: 10.1016/j.juro.2008.08.014. Epub 2008 Oct 18.
Percutaneous biopsy of small renal tumors has not been historically performed because of concern about complications and accuracy. We reviewed our experience with percutaneous needle biopsy of small renal masses to assess the safety and accuracy of the procedure, the potential predictors of a diagnostic result and the role of biopsy in clinical decision making.
A total of 100 percutaneous needle biopsies of renal masses less than 4 cm were performed between January 2000 and May 2007 with 18 gauge needles and a coaxial technique under ultrasound and/or computerized tomography guidance. A retrospective chart review was performed to document the complication rate and the ability to obtain sufficient tissue for diagnosis. Tumor size, tumor type (solid vs cystic), image guidance, biopsy number and core length were assessed for the ability to predict a diagnostic biopsy.
No tumor seeding or significant bleeding was observed. Of the core biopsies 84 (84%) were diagnostic for a malignant (66) or a benign (18) tumor. Larger tumor size and a solid pattern were significant predictors of a diagnostic result. Histological subtyping and grading were possible on core biopsies in 93% and 68% of renal cell carcinomas, respectively. A total of 20 patients underwent surgery after a diagnostic biopsy. The histological concordance of biopsies and surgical specimens was 100%.
Percutaneous needle biopsy of renal masses less than 4 cm is safe and provides adequate tissue for diagnosis in most cases. Larger tumor size and a solid pattern are significant predictors of a successful biopsy. Renal tumor biopsy decreases the rate of unnecessary surgery for benign tumors and can assist the clinician with treatment decision making, especially in elderly and unfit patients.
由于担心并发症和准确性，以往未对小肾肿瘤进行经皮活检。我们回顾了我们对小肾肿块经皮针吸活检的经验，以评估该操作的安全性和准确性、诊断结果的潜在预测因素以及活检在临床决策中的作用。
2000年1月至2007年5月期间，在超声和/或计算机断层扫描引导下，使用18号针和同轴技术对100例直径小于4 cm的肾肿块进行了经皮针吸活检。进行回顾性图表审查以记录并发症发生率和获得足够组织用于诊断的能力。评估肿瘤大小、肿瘤类型（实性与囊性）、图像引导、活检次数和芯长度对诊断性活检的预测能力。
未观察到肿瘤种植或明显出血。在芯活检中，84例（84%）对恶性（66例）或良性（18例）肿瘤具有诊断价值。较大的肿瘤大小和实性模式是诊断结果的重要预测因素。在93%的肾细胞癌芯活检中分别可以进行组织学亚型分类和分级，68%的肾细胞癌芯活检可以进行分级。共有20例患者在诊断性活检后接受了手术。活检与手术标本的组织学一致性为100%。
对直径小于4 cm的肾肿块进行经皮针吸活检是安全的，并且在大多数情况下能提供足够的组织用于诊断。较大的肿瘤大小和实性模式是成功活检的重要预测因素。肾肿瘤活检可降低良性肿瘤不必要的手术率，并可协助临床医生进行治疗决策，尤其是在老年和身体状况不佳的患者中。
