Related Experiment Video
Updated: Oct 25, 2025
In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses
Published on: March 30, 2015
Feasibility and Outcomes of Renal Mass Biopsy for Anatomically Complex Renal Tumors
Selma Masic1, Marshall Strother1, Laura C Kidd1
1The Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center - Temple Health, Philadelphia, PA.
Objective:
To compare the feasibility and outcomes of renal mass biopsies (RMB) of anatomically complex vs non-complex renal masses.
Methods:
Our institutional renal tumor database was queried for patients who underwent RMB between 2005 and 2019 and with available nephrometry score. Complex masses were: (1) small (<2 cm), (2) entirely endophytic (nephrometry E=3), (3) hilar (h) or (4) partially endophytic (E=2) and anterior. Demographic and pathologic data were compared. Biopsies were deemed adequate if they resulted in a diagnosis. Concordance with surgical pathology was assessed. These were both presented using proportions. Factors associated with biopsy outcomes were identified using multivariable logistic regression. RMB sensitivity and specificity were calculated using contingency methods.
Results:
A total of 306 RBMs were included, 179 complex and 127 non-complex. A total of 199 (65%) had an extirpative procedure. Complex lesions were less likely to have an adequate biopsy (89% vs 96%, P = .03), and to be concordant with final surgical pathology from an oncologic standpoint (89% vs 97%, P = .03). There was no significant difference in concordance of histology (76% vs 86%, P = .10) or grade (48 vs 51%, P = .66). On multivariable analyses, only male gender was associated with biopsy adequacy (OR 3.31, 95% CI 1.28-8.55, P = .01). Our overall sensitivity was 93%, specificity 93%, and accuracy 93%. There were no significant differences over time in biopsy outcomes during the study period.
Conclusion:
RMB of complex lesions is associated with excellent diagnostic yield, albeit lower than non-complex lesions. RMB should not be deferred in cases of anatomically complex lesions where additional data could improve clinical decision-making.
Insights
Renal mass biopsies (RMB) are feasible for complex lesions, yielding high diagnostic accuracy. Despite lower adequacy rates than non-complex masses, RMB is valuable for informed clinical decisions.
Area of Science:
- Urology
- Oncology
- Diagnostic Imaging
Background:
- Renal masses require accurate diagnosis for appropriate management.
- Anatomical complexity can pose challenges for diagnostic procedures like renal mass biopsy (RMB).
Purpose of the Study:
- To compare the feasibility and diagnostic outcomes of RMB for anatomically complex versus non-complex renal masses.
- To assess the impact of lesion complexity on biopsy adequacy and concordance with surgical pathology.
Main Methods:
- Retrospective analysis of 306 renal mass biopsies (2005-2019) with available nephrometry scores.
- Complex masses defined by size, endophytic nature, or hilar location.
- Comparison of biopsy adequacy, oncologic concordance, histology, and grade between complex and non-complex groups.
Main Results:
- Complex lesions had lower biopsy adequacy (89% vs. 96%) and oncologic concordance (89% vs. 97%) compared to non-complex lesions.
- No significant differences in histology or grade concordance were observed.
- Male gender was the only factor associated with biopsy adequacy.
Conclusions:
- Renal mass biopsy of complex lesions demonstrates excellent diagnostic yield, though slightly lower than non-complex lesions.
- RMB should be considered for complex renal masses to aid clinical decision-making.
- The diagnostic performance of RMB remains high, with overall sensitivity, specificity, and accuracy at 93%.
