Renal Tumor Biopsy: Rationale to Avoid Surgery in Small Renal Masses

Area of Science:

• Urology
• Oncology
• Diagnostic Imaging

Background:

• Small renal masses (SRMs) are common, but many are benign.
• Current practice often leads to unnecessary surgery for benign SRMs.
• Renal tumor biopsy (RTB) is underutilized despite its safety and accuracy.

Purpose of the Study:

• To evaluate the diagnostic rates of RTB for SRMs.
• To assess the concordance between RTB and surgical pathology.
• To determine the number of procedures avoided due to benign RTB findings.

Main Methods:

• Retrospective analysis of 182 patients with SRMs (≤4 cm) undergoing computed tomography-guided RTB.
• Evaluation of diagnostic yield, concordance with surgical pathology, and avoidance of active treatment.
• Analysis of adverse events and factors influencing diagnostic biopsy.

Main Results:

• RTB achieved an overall diagnostic rate of 90.6% (154/182 initially, with 11 more on repeat).
• Active treatment was avoided in 27.5% of patients due to benign diagnoses.
• High concordance was observed between RTB histology and final pathology (96%).
• Adverse events were minor (Clavien-Dindo grade I) in approximately 4% of cases.

Conclusions:

• RTB is a safe and effective method for diagnosing SRMs.
• Increased utilization of RTB can significantly reduce unnecessary surgical interventions.
• RTB should be integrated into multidisciplinary decision-making for SRMs.