Introduction

The role of renal biopsy prior to surgical intervention for a renal mass remains controversial despite the fact that for all other urological organs except the testicle, biopsy inevitably precedes treatment as is true for all other specialties dealing with solid masses (e.g. thyroid, breast, colon, liver, etc.). Accordingly, we sought to determine the impact of a routine biopsy regimen on the course of patients with cT1a lesions in comparison with a contemporary series of cT1a individuals who went directly to treatment without a preoperative biopsy.

Methods

We analyzed a multi-institutional, prospectively maintained database of patients who underwent an office-based, ultrasound-guided, renal mass biopsy (RMB) for a cT1a renal mass (i.e. ≤4cm in largest dimension). Controls were selected from all patients in the database who had a cT1a renal lesion but did not undergo RMB. Both groups were analyzed for differences in treatment modality and surgical pathology results.

Results

A total of 72 RMB and 73 control patients were analyzed. The groups were similar in regards to their baseline characteristics. Overall RMB diagnostic rate was 75%. Surgical pathology revealed that excision of benign tumors was eight-fold less in the RMB cohort compared to the control group (3% vs. 23%; P < 0.001). Additionally, the rate of active surveillance in the RMB cohort was nearly three times higher at 35% vs. 14% for the controls (P < 0.001). Biopsy was concordant with surgical pathology in 97% of cases for primary histology (i.e. benign vs. malignant), 97% for histologic subtype, and 46% for low (I or II) vs. high (III or IV) grade. On multivariate analysis patients who underwent surgical intervention without preoperative RMB were 6.7 times more likely to have benign histopathology compared to patients who underwent preoperative RMB (OR 6.7, 95% CI = 0.714 – 63.626, P = 0.096). There were no procedural or post-procedural RMB complications.

Conclusions

For patients with cT1a lesions, the implementation of routine office-based RMB led to a significant decrease in the rate of surgical intervention for benign tumors. This practice also resulted in a higher rate of active surveillance for the management of renal cortical neoplasms with benign histopathology compared to a control group.

中文翻译：

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术前肾肿块活检能否改变临床实践并减少小肾肿块的手术干预？

介绍

尽管对于除睾丸以外的所有其他泌尿器官，活检不可避免地先于治疗，对于处理实体肿块的所有其他专科（例如甲状腺、乳房、结肠、肝脏等）。因此，我们试图确定常规活检方案对 cT1a 病变患者病程的影响，并与当代一系列未经术前活检直接接受治疗的 cT1a 个体进行比较。

方法

我们分析了一个多机构、前瞻性维护的患者数据库，这些患者接受了基于诊室的、超声引导下的肾脏肿块活检 (RMB)，以发现 cT1a 肾脏肿块（即最大尺寸≤4cm）。从数据库中所有患有 cT1a 肾损伤但未接受 RMB 的患者中选择对照。分析两组治疗方式和手术病理结果的差异。

结果

共分析了 72 名人民币和 73 名对照患者。这些组的基线特征相似。总体人民币诊断率为75%。手术病理学显示，与对照组相比，RMB 队列中良性肿瘤的切除量减少了 8 倍（3% 对 23%；P < 0.001）。此外，人民币队列的主动监测率几乎高出三倍，为 35%，而对照组为 14%（P< 0.001)。在 97% 的原发组织学（即良性与恶性）病例、97% 的组织学亚型和 46% 的低（I 或 II）与高（III 或 IV）级病例中，活检与手术病理学一致。在多变量分析中，与接受术前 RMB 的患者相比，在没有术前 RMB 的情况下接受手术干预的患者发生良性组织病理学的可能性高 6.7 倍（OR 6.7，95% CI = 0.714 – 63.626，P  = 0.096）。没有手术或手术后的人民币并发症。

结论

对于cT1a病变患者，常规门诊RMB的实施导致良性肿瘤手术干预率显着降低。与对照组相比，这种做法还导致对具有良性组织病理学的肾皮质肿瘤的主动监测率更高。