Technique for Office-Based, Ultrasound-Guided Percutaneous Biopsy of Renal Cortical Neoplasms

Abstract

Introduction: Recent advances in axial imaging have resulted in a dramatic increase in the diagnoses of renal cortical neoplasms (RCNs), but no radiographic test can reliably distinguish benign from malignant lesions.1 Routine biopsy of RCNs may help guide management and reduce the number of unnecessary surgeries. In this video, we describe a technique for office-based, ultrasound-guided percutaneous RCN biopsy (UG-PRB) using a novel facilitated ultrasound targeting technology. Materials and Methods: The patient is instructed to stop anticoagulant and antiplatelet agents before the procedure. Two hours before the procedure, the patient self-administers a low dose benzodiazepine and applies EMLA cream (lidocaine-prilocaine topical cream 2.5%2.5%) to a pre-established flank site, which is then covered with an adhesive dressing. For the procedure, the patient is draped using the sterile technique in the prone position. The tumor is identified using a novel facilitated ultrasound targeting technology (Alpha 7 system; Hitachi-Aloka Medical, Ltd., Tokyo, Japan); this device projects a virtual needle path on the ultrasound screen, as is already common for prostate biopsies. The skin is anesthetized, and then an 18-gauge biopsy needle is inserted through a needle guide on the transducer toward the RCN. The patient helps the surgeon by holding his or her breath at the appropriate time. The needle is advanced along the projected dotted line in real time to the edge of the tumor, and a core is acquired. Several cores can be acquired in this manner. Ultrasound is repeated 1 hour later to assess for hematoma, and a urine sample is obtained before the discharge home to rule out significant hematuria. Results: We performed six office-based UG-PRBs for RCNs. Five of the six (83%) biopsies resulted in a tissue diagnosis, and the mean procedure time was 15.2 minutes. There were no intra- or postprocedural complications, and patients reported minimal to no pain. Conclusion: Our preliminary experience demonstrates that office-based UG-PRB is safe and effective. The information gained from the biopsy can be used to individualize the treatment plan for each patient. No competing financial interests exist. Runtime of video: 2 mins 48 secs