Does Biopsy of Renal Masses Obviate the Need for Thermal Ablation?
Biopsy results of renal masses rarely obviated the need for subsequent ablation and can safely be performed alongside image-guided tumor ablation (IGTA), according to a study published in the Journal of Vascular and Interventional Radiology.
A retrospective review of one institution's database found 401 consecutive percutaneous renal mass IGTAs performed between April 2000 and April 2015. The study cohort included 369 ablation events in 342 patients; patients were grouped according to those who had IGTA performed with a biopsy and those who had it performed without a biopsy. The size, malignancy/benignity, and pathology of each lesion was categorized.
Of the 369 ablation events, 317 (85.9%) had IGTA performed with biopsy; of those 317 ablations, overall diagnostic yield for percutaneous biopsy was 94.3%. Based on biopsy results, 82.6% (262/317) were classified as malignant or suspicious, 9.5% (30/317) were classified as likely benign, and 2.2% (7/317) were classified as definitively benign. The researchers designated only definitively benign lesions as not needing IGTA. In the remaining 97.8% (310/317), IGTA was supported by biopsy results.
The researchers concluded that in only a small percentage of cases (2.2%) did biopsy of renal masses with suspicious imaging features negate the need for IGTA.
“For patients for who have undergone counseling and have elected to forgo active surveillance and surgical options, biopsy can safely be performed concomitantly with ablation,” the authors concluded.
Tsang Mui Chung MS, Maxwell AW, Wang LJ, et al. Should renal mass biopsy be performed prior to or concomitantly with thermal ablation? J Vasc Interv Radiol. Jul 31 2018. pii: S1051-0443(18)31160-6. doi: 10.1016/j.jvir.2018.04.028. [Epub ahead of print]