Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan.
Department of Radiological Technology, Faculty of Health Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama, 700-8558, Japan.
Jpn J Radiol. 2024 Mar;42(3):319-325. doi: 10.1007/s11604-023-01496-x. Epub 2023 Oct 14.
This single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy.
Forty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6-5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. "First specimen" and "all specimens" were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists.
Multiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020).
Biopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.
本单中心、单臂、前瞻性、开放标签研究旨在评估肾肿瘤活检中单针或多针穿刺的最佳针数。
共纳入 44 例 44 个肿瘤（平均直径 2.7±1.0cm；范围 1.6-5.0cm）的 44 次活检。在超声或 CT 透视引导下，使用 18 号切割针和同轴方法进行活检。获取 2 个或更多标本，将其分为首次和后续标本。两位经过董事会认证的病理学家分别独立且盲法对“首次标本”和“所有标本”进行组织学评估（即标本的适宜性、组织学诊断、亚型和肾细胞癌 [RCC] 的 Fuhrman 分级）。
所有活检均成功、安全地获取了多个标本。所有肿瘤均进行了组织学诊断；40 个恶性肿瘤包括 39 个 RCC 和 1 个孤立性纤维瘤，4 个良性病变包括 2 个血管平滑肌脂肪瘤、1 个嗜酸细胞瘤和 1 个毛细血管血管瘤。所有 RCC 中均可确定亚型（32 个透明细胞 RCC、4 个嫌色细胞 RCC 和 3 个乳头状 RCC），38 个 RCC 中确定了 Fuhrman 分级。仅评估首次标本时，22.7%的标本不适合诊断，34 个（77.3%）标本进行了组织学诊断。诊断率显著低于所有标本（P=0.0044）。单因素分析显示，病变较小是诊断失败的显著预测因素（P=0.020）。
多针穿刺活检显著提高了诊断率。因此，操作者在进行肾肿瘤活检时应获取多个核心组织。
