Blute Michael L, Drewry Anna, Abel Edwin Jason
Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Assistant Professor, Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705-2281, USA.
Ther Adv Urol. 2015 Oct;7(5):265-74. doi: 10.1177/1756287215585273.
The increased use of abdominal imaging has led to identification of more patients with incidental renal masses, and renal mass biopsy (RMB) has become a popular method to evaluate unknown renal masses prior to definitive treatment. Pathologic data obtained from biopsy may be used to guide decisions for treatment and may include the presence or absence of malignant tumor, renal cell cancer subtype, tumor grade and the presence of other aggressive pathologic features. However, prior to using RMB for risk stratification, it is important to understand whether RMB findings are equivalent to pathologic analysis of surgical specimens and to identify any potential limitations of this approach. This review outlines the advantages and limitations of the current studies that evaluate RMB as a guide for treatment decision in patients with unknown renal masses. In multiple series, RMB has demonstrated low morbidity and a theoretical reduction in cost, if patients with benign tumors are identified from biopsy and can avoid subsequent treatment. However, when considering the routine use of RMB for risk stratification, it is important to note that biopsy may underestimate risk in some patients by undergrading, understaging or failing to identify aggressive tumor features. Future studies should focus on developing treatment algorithms that integrate RMB to identify the optimal use in risk stratification of patients with unknown renal masses.
腹部影像学检查的使用增加，使得更多偶然发现肾肿物的患者得以确诊，肾肿物活检（RMB）已成为在确定性治疗前评估不明肾肿物的常用方法。活检获得的病理数据可用于指导治疗决策，可能包括是否存在恶性肿瘤、肾细胞癌亚型、肿瘤分级以及其他侵袭性病理特征。然而，在将RMB用于风险分层之前，了解RMB结果是否等同于手术标本的病理分析以及识别该方法的任何潜在局限性非常重要。本综述概述了当前评估RMB作为不明肾肿物患者治疗决策指南的研究的优缺点。在多个系列研究中，RMB已显示出低发病率，并且如果通过活检识别出良性肿瘤患者并避免后续治疗，理论上还能降低成本。然而，在考虑将RMB常规用于风险分层时，需要注意活检可能会在某些患者中通过低估分级、分期或未能识别侵袭性肿瘤特征而低估风险。未来的研究应专注于开发整合RMB的治疗算法，以确定其在不明肾肿物患者风险分层中的最佳应用。
