Diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses: Should we biopsy all that are indeterminate?

OBJECTIVE. The purpose of our study was to report the diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses. MATERIALS AND METHODS. We retrospectively reviewed all percutaneous renal biopsies of solid masses performed at our institution over 83 consecutive months from May 1998 to March 2005 through a query of our radiology department procedure database. Fifty-five CT and three sonographic biopsies were performed at our institution during this time. A solid renal mass was documented prior to biopsy by contrast-enhanced CT (n = 48), gadolinium-enhanced MRI (n = 6), or sonography (solid noncystic masses, n = 4). The average maximal mass diameter was 3.1 cm (range, 1.0-11.0 cm). Forty-seven (81%) of the 58 biopsies were performed immediately before percutaneous ablation. Forty-four (76%) of the biopsies were performed using a coaxial technique with side-cutting automated biopsy needles (16-20 gauge), and 14 (24%) were fine-needle aspirations with a Franseen needle (20 gauge) using a tandem technique. In 19 cases, immunohistochemistry or histochemistry (Hale colloidal iron stain) was used to establish or confirm the diagnosis. Medical records and radiology and pathology reports were reviewed for all patients. RESULTS. An adequate sample size was obtained in 55 (95%) of 58 renal masses and led to a definitive diagnosis in 52 (90%) of the 58. Renal cell carcinoma accounted for 36 (69%) of 52 diagnostic biopsies. The diagnosis of a benign lesion was made in 14 (27%) of 52 biopsies. Lymphoma (1/58) and metastatic disease (1/58) accounted for the remaining two diagnostic biopsies. Three biopsy samples obtained inadequate sample volumes, and an additional three samples were thought to have adequate sample volume but were not diagnostic. A single false-negative biopsy result was identified after growth was seen on follow-up imaging and subsequent nephrectomy revealed renal cell carcinoma. CONCLUSION. Imaging-guided biopsy of a solid enhancing renal mass was diagnostic in 52 (90%) of 58 consecutive biopsies. The diagnosis of a benign lesion was made in 27% of diagnostic biopsies. Because of the advances in biopsy and histology techniques, the role of imaging-guided biopsy should be reconsidered.