Londoño Diana C, Wuerstle Melanie C, Thomas Anil A, Salazar Luis E, Hsu Jin-Wen Y, Danial Tarek, Chien Gary W
Urology Resident at the Sunset Medical Center in Los Angeles, CA. E-mail:
Perm J. 2013 Summer;17(3):4-7. doi: 10.7812/TPP/12-110.
Percutaneous renal biopsy in patients with renal masses is increasing. We investigated the accuracy of percutaneous renal mass biopsy results in patients undergoing evaluation of solid renal masses.
A retrospective review was performed of patients in the Kaiser Permanente Southern California Region who underwent computed tomography or ultrasound-guided percutaneous renal biopsy of a solid renal mass between January 2005 and December 2009. Patients were stratified by size of mass (≤ 4 cm vs > 4 cm). Initial biopsy results were correlated with final pathology specimens after extirpation.
Medical records of 126 patients (129 renal units with 132 biopsies) were reviewed. Initial diagnostic biopsies revealed 87 (66%) malignant, 38 (29%) benign, and 7 (5%) nondiagnostic lesions. Sixty-three patients (50%) ultimately underwent extirpative surgery (23 partial and 40 radical nephrectomies). Of these patients, the diagnostic accuracy of the initial percutaneous renal mass biopsy was 76%, with an overall sensitivity and specificity of 75.4% and 100%, respectively. The biopsy concordance to final histologic tumor subtype was 93%. Larger tumor size (odds ratio [OR], 2.20; 95% confidence interval [CI], 0.55 to 8.88) and increasing number of biopsies (OR, 2.50; 95% CI, 0.59 to 10.69) were associated with increasing accuracy of a biopsy result to predict cancer; however, these associations were not statistically significant.
Percutaneous renal mass biopsy is diagnostically accurate and has good sensitivity, specificity, and concordance with final pathologic renal cell carcinoma subtype. This diagnostic modality can assist in management of select renal masses as treatment options are expanding.
肾肿块患者的经皮肾活检正在增多。我们研究了经皮肾肿块活检结果在接受实性肾肿块评估患者中的准确性。
对2005年1月至2009年12月在南加州凯撒医疗集团接受计算机断层扫描或超声引导下经皮实性肾肿块活检的患者进行回顾性研究。患者按肿块大小分层（≤4 cm与>4 cm）。初始活检结果与切除后的最终病理标本进行对照。
回顾了126例患者（129个肾单位，132次活检）的病历。初始诊断性活检显示87例（66%）为恶性，38例（29%）为良性，7例（5%）为非诊断性病变。63例患者（50%）最终接受了切除手术（23例部分肾切除术和40例根治性肾切除术）。在这些患者中，初始经皮肾肿块活检的诊断准确性为76%，总体敏感性和特异性分别为75.4%和100%。活检与最终组织学肿瘤亚型的一致性为93%。肿瘤较大（优势比[OR]，2.20；95%置信区间[CI]，0.55至8.88）和活检次数增加（OR，2.50；95%CI，0.59至10.69）与活检结果预测癌症的准确性增加相关；然而，这些相关性无统计学意义。
经皮肾肿块活检诊断准确，具有良好的敏感性、特异性，且与最终病理肾细胞癌亚型一致。随着治疗选择的不断扩展，这种诊断方式可有助于某些肾肿块的管理。
