MP35-17 MULTI-QUADRANT BIOPSY TECHNIQUE DECREASES SAMPLING ERROR IN LARGE HETEROGENEOUS RENAL TUMORS

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2015MP35-17 MULTI-QUADRANT BIOPSY TECHNIQUE DECREASES SAMPLING ERROR IN LARGE HETEROGENEOUS RENAL TUMORS Jennifer E. Heckman, Timothy Ziemlewicz, Sara Best, Meghan Lubner, Louis Hinshaw, David F. Jarrard, Tracy Downs, Wei Huang, Fred T. Lee, Stephen Y. Nakada, and E. Jason Abel Jennifer E. HeckmanJennifer E. Heckman More articles by this author , Timothy ZiemlewiczTimothy Ziemlewicz More articles by this author , Sara BestSara Best More articles by this author , Meghan LubnerMeghan Lubner More articles by this author , Louis HinshawLouis Hinshaw More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , Tracy DownsTracy Downs More articles by this author , Wei HuangWei Huang More articles by this author , Fred T. LeeFred T. Lee More articles by this author , Stephen Y. NakadaStephen Y. Nakada More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1118AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard percutaneous renal mass biopsy is prone to sampling error in large heterogeneous renal masses, which increases the risk for non-diagnostic results or failure to detect poor prognostic features. The purpose of this study was to compare the accuracy of percutaneous biopsy for large renal masses using a modified multi-quadrant technique (qBx) to standard biopsy technique. METHODS Clinical and pathologic data for all patients with ≥ cT2 renal masses who received percutaneous biopsy using standard or modified techniques at a single institution over a five year period (2009 – 2014) were reviewed with IRB approval. The qBx technique includes multiple core biopsies from at least four separate, solid enhancing areas within the tumor. Standard technique obtained core samples from < 4 areas within the tumor. An expert genitourinary pathologist (WH) performed a blinded review of each biopsy core. RESULTS In patients with ≥ cT2 renal masses, 110 biopsies were performed in 105 patients (45 standard technique and 65 qBx). Mean clinical tumor size was 10 cm (IQR 8-13). Biopsy was non-diagnostic in 5/45 (11.1%) standard and 0/65 (0%) qBx. Nephrectomy was performed after 66 biopsies (21 standard and 45 qBx). When comparing the concordance of biopsy pathology to nephrectomy specimens, biopsy correctly predicted the type of renal neoplasm in 17/18 (94.4%) standard biopsies and 45/45 (100%) qBx. In 57 RCC tumors, grade was assigned for both biopsy and nephrectomy specimens. Tumor grade was concordant in 2/14 (14.3%) of standard biopsies and 27/43 (62.8%) qBx. Sarcomatoid de-differentiation was identified in 16/88 (18.2%) of large RCC tumors studied. Sarcomatoid features were identified from biopsy in 10/16 (62.5%) tumors. The ability to identifying sarcomatoid features was higher using multi-quadrant technique compared to the standard technique, 8/10 (80.0%) vs 2/6 (33.3%). One patient who had a biopsy using the standard technique required hospital admission for hemorrhage. No complications were reported in patients when using the qBx technique. CONCLUSIONS Multi-quadrant biopsy technique increases diagnostic accuracy in large renal tumors. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e426 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer E. Heckman More articles by this author Timothy Ziemlewicz More articles by this author Sara Best More articles by this author Meghan Lubner More articles by this author Louis Hinshaw More articles by this author David F. Jarrard More articles by this author Tracy Downs More articles by this author Wei Huang More articles by this author Fred T. Lee More articles by this author Stephen Y. Nakada More articles by this author E. Jason Abel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...