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Fine needle aspiration of renal cortical lesions in adults

Adebowale J Adeniran1, Hikmat Al-Ahmadie, Pratibha Iyengar

  • 1Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.

Diagnostic Cytopathology
|December 2, 2009
PubMed

Insights

Fine needle aspiration (FNA) biopsy of renal lesions shows high accuracy for conventional renal cell carcinoma (RCC) but lower accuracy for other subtypes. Ancillary studies are crucial for subclassification and targeted treatment of renal neoplasms.

Area of Science:

  • Oncology
  • Pathology
  • Nephrology

Background:

  • Historically, fine needle aspiration (FNA) for renal cortical lesions was controversial due to limited impact on clinical management.
  • Surgical resection was the standard for most renal cortical lesions, except metastases.
  • Advances in neoadjuvant targeted therapies necessitate precise histological subtyping of renal cortical tumors.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of fine needle aspiration (FNA) cytology for various renal cortical lesions.
  • To assess the utility of FNA in identifying histological subtypes critical for targeted therapy selection.
  • To determine the role of ancillary studies in improving the subclassification of renal cortical neoplasms.

Main Methods:

  • Retrospective analysis of 143 consecutive renal cortical lesions evaluated post-nephrectomy over a 2-year period.
  • Preparation of both air-dried smears and ThinPrep® slides from all specimens.
  • Cytological review and comparison with definitive histological diagnoses, using Diff-Quick and Papanicolaou stains.

Main Results:

  • Cytology demonstrated high accuracy in diagnosing conventional renal cell carcinoma (RCC).
  • Accuracy was significantly lower for papillary RCC, chromophobe RCC, and papillary urothelial carcinoma.
  • The findings highlight limitations of FNA alone for precise subtyping of diverse renal cortical neoplasms.

Conclusions:

  • Fine needle aspiration (FNA) cytology is effective for diagnosing conventional RCC but less so for other subtypes.
  • Accurate histological subclassification of renal cortical neoplasms is essential for current targeted treatment strategies.
  • Incorporating ancillary studies alongside FNA cytology is recommended to enhance diagnostic accuracy for targeted therapy.

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