Reply

Abstract

I first thank the editor for writing excellent comments on this article. The real question is “Who really needs a needle biopsy and will it gain acceptance as a diagnostic tool?” Percutaneous renal needle biopsy is accepted as the main diagnostic tool in unresectable renal cell carcinoma, metastatic masses, and lymphoma. 1 Sahni V.A. Silverman S.G. Biopsy of renal masses: when and why. Cancer Imaging. 2009; 9: 44-55 Crossref PubMed Scopus (60) Google Scholar Widespread use of imaging modalities has led to the increased diagnosis of small renal masses. If we consider small renal masses in the largest series of partial nephrectomy, 28%-34% of masses removed were benign at final pathology. 2 Gill I.S. Kavoussi L.R. Lane B.R. et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178: 41-46 Abstract Full Text Full Text PDF PubMed Scopus (961) Google Scholar , 3 Venkatesh R. Weld K. Ames C.D. et al. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology. 2006; 67: 1169-1174 Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar However, small renal masses, detected in elderly patients who have comorbidities and are at high risk for postoperative morbidity and mortality, can be treated with ablative therapies such as cryotherapy, radiofrequency ablation, thermoablation, and active surveillance. In these clinical settings, needle biopsy is the only tool for histopathologic data available. Percutaneous renal needle core biopsy has an acceptable sensitivity and specificity in the diagnosis of renal masses being 91.4% and 60% in our study, respectively. Based on recent findings and published data, if practice is sufficient, the biopsy results have the potential to affect treatment decisions. As a conclusion, practicing urologists should increase the use of renal biopsies for suspicious masses to better characterize these masses preoperatively. Editorial CommentUrologyVol. 76Issue 3PreviewThe authors add to the literature an experience of 42 patients who underwent ultrasound-guided, 2-core 18-gauge needle biopsies of a kidney mass followed by surgical resection. In 39 of 42 cases (92.8%) an accurate diagnosis was achieved and in 36 of 40 cases (90%) a malignant mass could be differentiated from a benign mass. However, histologic subtype was correctly determined in 31 of 40 cases (77.5%) and Fuhrman grade in 17 of 33 cases (51.5%). No serious adverse events occurred after the biopsies. Full-Text PDF