ORIGINAL ARTICLE   

Minerva Urology and Nephrology 2021 February;73(1):78-83

DOI: 10.23736/S2724-6051.20.03519-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of renal biopsy to improve small renal mass diagnosis and management: are there predictive factors for a higher detection rate?. The first Italian study of 100 cases

Maida BADA ¹ ✉, Sebastiano RAPISARDA ², Calogero CICERO ³, Marina DI MAURO ², Marco SEBBEN ⁴, Bernardino DE CONCILIO ¹, Guglielmo ZECCOLINI ¹, Giorgio MAZZON ¹, Antonio CELIA ¹

¹ Department of Urology, S. Bassiano Hospital, Bassano del Grappa, Vicenza, Italy; ² Gaspare Rodolico Hospital, University of Catania, Catania, Italy; ³ Department of Radiology, S. Bassiano Hospital, ULSS 7 Pedemontana, Bassano del Grappa, Vicenza, Italy; ⁴ Confortini Surgery Hub, Verona University Hospital, Civile Maggiore Hospital, Verona, Italy

BACKGROUND: Incidence of small renal masses (SRMs) has increased over the last decade: in order to reduce overtreatment of benign lesions, renal tumor biopsy (RTB) has been advocated. The primary aim of this study were to establish the rate of diagnostic biopsies and the concordance rate between RTB and surgical pathology with regard to tumor histology. The secondary aim was to identify what predictive factors are associated with an initial diagnostic biopsy.
METHODS: We retrospectively analyzed RTB performed in our center in patients with SRMs between 2015 and 2017. We assessed patient demographics and clinical status, lesion characteristics and procedural factors. The categorical variables were tested with the chi-square test. We used univariate and multivariate analysis to identify what factors are indicative of non-diagnostic biopsies. We used the SPSS statistics v. 23.
RESULTS: We performed a total of 100 RTBs to management 94 patients. The initial biopsy was diagnostic in 88 patients (67 malignant and 21 benign lesion). The six remaining patients had repeat biopsies, of which four were diagnostic. Complications rate was 5% prevalently local hematoma treated with surveillance. Agreement between biopsy and surgical histology was found in 94% of cases. On contingency analysis and on univariate and multivariate analysis, these factors (age, tumor size, exophytic location, and type of imaging used) were not predictive with diagnostic biopsy.
CONCLUSIONS: RTB for SRMs helps establish pre-treatment diagnosis, reduce overtreatment, with a low risk of complications and high diagnostic rate. In our experience, we did not find predictive factors more likely associated with a diagnostic biopsy.

KEY WORDS: Kidney neoplasms; Adrenal incidentaloma; Early diagnosis; Biopsy; Early detection of cancer