Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands.
J Endourol. 2011 Sep;25(9):1463-8. doi: 10.1089/end.2010.0693. Epub 2011 Jul 28.
The histopathologic diagnosis of a small renal mass (SRM) that is managed with cryoablation relies on preoperative or intraoperative biopsies. Because a considerable number of these SRMs are benign, accurate diagnosis has prognostic and follow-up implications. The main problem in SRMs is the high rate of nondiagnostic biopsies. Our purpose was to assess whether certain tumor and biopsy characteristics are correlated with a diagnostic biopsy outcome.
One hundred tumors that were smaller than 4.5 cm in 94 patients were managed with laparoscopic cryoablation. After dissection of the perirenal fat and identification of the tumor by intra-abdominal ultrasonography, one or more biopsies were obtained before freezing. Using the Student t/Mann Whitney U test, the following parameters were evaluated for predicting biopsy outcome: Tumor size, location, and exophytic part of the tumor, size of the biopsy needle, the number of biopsies taken, and presence of nonenhancing areas compatible with necrosis inside the tumors. Correlations among parameters were assessed using a Spearman correlation or Kruskal-Wallis test.
Twenty-two (22%) biopsies were nondiagnostic and consisted of normal kidney tissue, connective tissue, fat, fibrosis, necrosis, and/or blood. There were no significant differences in parameters between the diagnostic and nondiagnostic group. There was a positive correlation between tumor size and number of biopsies (P=0.029) and between the presence of nonenhancing areas and both size (P<0.001) and the number of biopsies taken (P<0.001).
No statistical significant correlation was found between biopsy outcome and tumor or biopsy characteristics. More biopsies were taken in larger tumors, and larger tumors contained more nonenhancing areas that were suspect for necrosis.
接受冷冻消融治疗的小肾肿瘤（SRM）的组织病理学诊断依赖于术前或术中活检。由于相当数量的这些 SRM 是良性的，因此准确的诊断具有预后和随访意义。SRM 的主要问题是活检的诊断率低。我们的目的是评估某些肿瘤和活检特征是否与诊断性活检结果相关。
94 例患者的 100 个肿瘤小于 4.5cm，接受了腹腔镜冷冻消融治疗。在经腹膜后脂肪解剖和通过腹腔内超声识别肿瘤后，在冷冻前获取一个或多个活检。使用 Student t/Mann Whitney U 检验，评估以下参数以预测活检结果：肿瘤大小、位置和肿瘤的外生部分、活检针的大小、活检次数和肿瘤内与坏死相符的无增强区域。使用 Spearman 相关或 Kruskal-Wallis 检验评估参数之间的相关性。
22%（22 个）的活检是非诊断性的，包括正常肾组织、结缔组织、脂肪、纤维化、坏死和/或血液。诊断组和非诊断组在参数方面没有显著差异。肿瘤大小与活检次数呈正相关（P=0.029），无增强区与肿瘤大小（P<0.001）和活检次数（P<0.001）呈正相关。
未发现活检结果与肿瘤或活检特征之间存在统计学显著相关性。较大的肿瘤取更多的活检，较大的肿瘤包含更多的怀疑为坏死的无增强区。
