Mally Abhijith Dev, Gayed Bishoy, Averch Timothy, Davies Benjamin
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Can J Urol. 2012 Jun;19(3):6243-9.
There has been an increased incidence of small renal masses with a majority incidentally discovered in elderly patients or patients with several comorbidities. The historic role of renal biopsy has been limited due to initial concerns about accuracy and safety. This review analyses the current role of percutaneous renal biopsy.
A comprehensive literature review of PubMed and MEDLINE for reports of percutaneous needle core biopsy and fine needle aspiration of renal tumors that were published from 1977 to 2012.
With the adoption of new biopsy techniques, there is a very low risk of tumor seeding. Symptomatic complications are relatively low; less than 2% require any form of intervention. The accuracy has dramatically improved over the past decade. While about 10%-15% of small renal mass biopsies are indeterminate, the rate of false negative renal biopsies is only 1% in contemporary series. Recent studies suggest that biopsy results can be improved by combining histological and molecular analysis.
In contemporary series, renal mass biopsies (RMB) have a low complication rate and significantly improved accuracy. RMBs can better stratify patients into an active surveillance protocol and therefore potentially decrease the over treatment of small renal masses, especially in the elderly or patients with comorbidities.
小肾肿块的发病率有所上升，大多数是在老年患者或患有多种合并症的患者中偶然发现的。由于最初对准确性和安全性的担忧，肾活检的历史作用一直有限。本综述分析了经皮肾活检的当前作用。
对1977年至2012年发表的关于经皮针芯活检和肾肿瘤细针穿刺抽吸的报告进行全面的文献检索，检索数据库为PubMed和MEDLINE。
随着新活检技术的采用，肿瘤种植的风险非常低。有症状的并发症相对较少；不到2%的患者需要任何形式的干预。在过去十年中，准确性有了显著提高。虽然约10%-15%的小肾肿块活检结果不确定，但在当代系列研究中，肾活检假阴性率仅为1%。最近的研究表明，结合组织学和分子分析可以改善活检结果。
在当代系列研究中，肾肿块活检（RMB）的并发症发生率低，准确性显著提高。RMB可以更好地将患者分层纳入主动监测方案，从而有可能减少对小肾肿块的过度治疗，尤其是在老年患者或患有合并症的患者中。
