Institute of Radiology, University of Torino, Facoltà San Luigi Gonzaga, Orbassano (TO), Italy.
Eur Radiol. 2011 Feb;21(2):393-401. doi: 10.1007/s00330-010-1938-9. Epub 2010 Sep 1.
To review our method of perform needle biopsies of renal masses.
We analysed 150 consecutive imaging-guided percutaneous biopsies. The pathological diagnosis was verified on clinical outcome in 129 cases (40 surgical resection, 53 thermal ablation, two medical treatment and 34 watchful waiting). Twenty-six patients underwent fine-needle aspiration biopsy (FNAB), 45 core-needle biopsy (CB) and 58 FNAB + CB. After review by two expert pathologists, cumulative accuracy of all FNAB (84) and all CB (103) was calculated. The rate of complications and mass management other than surgery was estimated.
The final diagnosis was malignancy in 97 cases (benign mass in 32). FNAB correctly diagnosed 64/84 masses (76.2%), CB 96/103 (93.2%). Of 58 masses submitted for both FNAB and CB, CB provided a 22.5% accuracy improvement. Major and minor complications occurred in 0% and 5.3%. Renal biopsy altered clinical management in 89/129 cases (68.9%), in terms of choosing therapeutic options other than surgery.
CB is more accurate than FNAB and should be preferred in renal mass biopsy. FNAB may precede CB when an expert pathologist can immediately evaluate the samples. Renal biopsy influences renal mass management.
回顾我们对肾脏肿块进行经皮穿刺活检的方法。
我们分析了 150 例连续的影像学引导下经皮穿刺活检。129 例（40 例手术切除、53 例热消融、2 例药物治疗和 34 例观察等待）的临床结果证实了病理诊断。26 例患者接受了细针抽吸活检（FNAB），45 例接受了核心针活检（CB），58 例同时接受了 FNAB 和 CB。由两位专家病理学家进行复查后，计算了所有 FNAB（84 例）和所有 CB（103 例）的累积准确率。估计了并发症的发生率和除手术以外的肿块管理方法。
最终诊断为恶性肿瘤 97 例（良性肿块 32 例）。FNAB 正确诊断了 64/84 例（76.2%），CB 正确诊断了 96/103 例（93.2%）。58 例同时进行 FNAB 和 CB 的肿块中，CB 提高了 22.5%的准确率。主要和次要并发症的发生率分别为 0%和 5.3%。在 129 例中有 89 例（68.9%）的肾活检改变了临床管理，即选择了除手术以外的治疗方案。
CB 比 FNAB 更准确，在肾脏肿块活检中应优先选择。当有专家病理学家能立即评估样本时，FNAB 可先于 CB 进行。肾活检影响肾脏肿块的管理。
