The Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Radiology, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, 90095-7437, USA.
Abdom Radiol (NY). 2018 Jul;43(7):1813-1819. doi: 10.1007/s00261-017-1337-7.
To determine the efficacy, safety and clinical utility of CT and US-guided percutaneous renal mass biopsy.
A retrospective IRB-approved, HIPAA-compliant study of a cohort of 183 consecutive patients who underwent percutaneous, CT or US-guided renal mass biopsy (RMB) from March 2002 through December 2012 was performed. RMB was performed in 183 consecutive patients for suspected solid renal mass of whom 14/183 (7.7%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Ten patients had multiple biopsies for new growing masses. Using US, CT or CT/US fusion-guidance, a 17G or 19G cannula needle was placed at the margin of the mass and an 18G or 20G core biopsy gun was used to obtain several tissue cores. Renal parenchymal biopsies for medical renal diseases were excluded. Imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, immunohistochemical (IHC) studies, and subsequent final pathological diagnosis on nephrectomy were evaluated.
Of the 169 patients with 184 RMB, 121/169 (71.6%) were male with a mean age of 67.5 years. Of 184 RMB, 126 were malignant [126/184 (68.5%)], 37 [37/184 (20.1%)], were benign, and 21 (21/184 (11.4%) were nondiagnostic. IHC was performed in 131 biopsies (71.1%) and was diagnostic in 88.5% of those cases. Twenty-eight patients underwent subsequent partial nephrectomy; in 27/27 (100%) cases, RMB was concordant with nephrectomy for malignancy and in 21/27 (77.8%) RMB was concordant for subtype of RCC. Overall, the RMB sensitivity for detection of malignancy, specificity, and positive predictive value were 100%. The negative predictive value of benign RMB diagnosis was also 100%. There was a total of 14 (7.6%) complications, 13 minor (7.1%) and 1 major (0.5%). Of the minor complications, ten (5.5%) were postprocedural minor hematomas that resolved conservatively; one (0.5%) postprocedural vasovagal reaction; one (0.5%) episode of hematuria; and one (0.5%) episode of nausea and abdominal discomfort. No cases of renal pseudoaneurysm or tumor seeding attributed to biopsy were identified.
Percutaneous image-guided RMB is safe and highly diagnostic when combined with IHC and supports a greater role of RMB and imaging in evaluating renal masses when rendering appropriate treatments.
确定 CT 和 US 引导下经皮肾肿块活检的疗效、安全性和临床实用性。
对 2002 年 3 月至 2012 年 12 月期间连续 183 例接受经皮、CT 或 US 引导下肾肿块活检（RMB）的患者进行了回顾性 IRB 批准、符合 HIPAA 规定的研究。对 183 例连续患者进行 RMB，用于疑似实体肾肿块，其中 14/183（7.7%）因活检在外部机构进行、病历不完整或病变显示不佳而被排除。10 例患者因新生长的肿块进行了多次活检。使用 US、CT 或 CT/US 融合引导，将 17G 或 19G 套管针放置在肿块边缘，并使用 18G 或 20G 核心活检枪获取多个组织芯。排除用于治疗肾脏疾病的肾实质活检。评估了成像变量（包括大小、位置和疾病范围）、核心活检数量、患者人口统计学（年龄、性别）、临床指征、最终病理诊断、免疫组织化学（IHC）研究以及随后的肾切除术的最终病理诊断。
在 169 例有 184 例 RMB 的患者中，121/169（71.6%）为男性，平均年龄为 67.5 岁。在 184 例 RMB 中，126 例为恶性[126/184（68.5%）]，37 例[37/184（20.1%）]为良性，21 例[21/184（11.4%）]为非诊断性。对 131 例活检进行了 IHC 检查，其中 88.5%的病例具有诊断价值。28 例患者随后接受了部分肾切除术；在 27/27（100%）例中，RMB 与肾切除术的恶性程度一致，在 21/27（77.8%）例中，RMB 与 RCC 的亚型一致。总体而言，RMB 检测恶性肿瘤的灵敏度、特异性和阳性预测值均为 100%。良性 RMB 诊断的阴性预测值也为 100%。共有 14 例（7.6%）并发症，13 例为轻微（7.1%），1 例为严重（0.5%）。轻微并发症中，10 例（5.5%）为术后小血肿，保守治疗即可缓解；1 例（0.5%）为术后血管迷走神经反应；1 例（0.5%）为血尿；1 例（0.5%）为恶心和腹部不适。未发现活检引起的肾假性动脉瘤或肿瘤种植的病例。
经皮影像引导下 RMB 是安全且高度诊断性的，当与 IHC 联合使用时，在为适当治疗提供指导时，可发挥更大的 RMB 和影像学作用。
