Percutaneous ureteral biopsy: safety and diagnostic yield

Abstract

To evaluate safety and diagnostic yield of percutaneous CT-guided biopsy of extrarenal upper urinary tract lesions. Retrospective review of our institutional database of image-guided biopsies yielded 44 CT-guided percutaneous biopsies in 44 unique patients that targeted ureteral (30, 68%) or other non-renal upper urinary tract lesions (14, 32%) between January 1, 2000 and May 1, 2017. Indications, pre-biopsy imaging, biopsy technique, peri-procedural antithrombotic use, complications including bleeding defined by Society of Interventional Radiology criteria, pathology results, and subsequent imaging were reviewed up to 3months after the procedure to evaluate safety and diagnostic yield. Mean patient age was 66 (range 27-88) and 23/44 patients were male. The majority (34/44) of lesions were sampled with an 18-gauge biopsy device via a 17-gauge introducer needle, and the remaining 10/44 lesions were sampled with a 19/20 gauge system. The mean number of core samples obtained was 4 (range 2-10). No major complications occurred. Specifically, no patient developed a urine leak or urinary obstruction. Minor complications occurred in 3/44 (7%) biopsies, all retroperitoneal hemorrhages that did not require transfusion or other intervention. Biopsy was adequate for pathologic examination in 41 of 44 (93%) cases. Among patients undergoing surgical resection, biopsy diagnosis was concordant with surgical pathology in 9/10 (90%) cases and discordant in 1/10 (10%). CT-guided percutaneous biopsy of upper urinary tract lesions can be performed safely, with high diagnostic yield, and with a high rate of concordance on subsequent surgical pathology.