Evolving Role of Renal Mass Biopsy: Myths, Facts, and Misconceptions

Abstract

There are four reasons commonly offered by those opposed to the application of renal mass biopsy (RMB): (1) RMB is not useful because the lesion is almost certainly cancer; (2) RMB is not necessary because noninvasive techniques (i.e., cross-sectional imaging) are accurate enough to determine the risk of malignancy; (3) RMB is not safe; (4) RMB is not accurate. These are myths that can easily be debunked. There are three primary benefits to performing RMB: (1) RMB can help avoid intervention in cases of benign or nonaggressive tumor; (2) RMB may change the treatment plan if an unexpectedly aggressive renal malignancy is determined; (3) RMB might provide more assurance to both physician and patient regarding an active surveillance management plan. Overall, RMB should be considered in settings where this information would be useful, which is consistent with contemporary guidelines for the management of localized renal cancer. RMB is less useful in some patients at the extremes, such as an ill patient with a small renal mass where only an unusually aggressive malignancy would pose a threat or a patient with a long life expectancy and a larger renal mass where the lifetime risk of a missed malignancy is significant. In many patients, however, especially those aged 55–75 years and with masses 2–4 cm in size, RMB should be routinely offered.