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Immediate percutaneous renal mass biopsy following cryoablation: validation of diagnostic performance and clinical
Fatima Islam1, Beau Toskich2, David Thiel3
1Department of Interventional Radiology, Mayo Clinic, Jacksonville, USA. islam.fatima@mayo.edu.
Objectives:
Image-guided thermal ablation is a guideline-supported treatment for small renal tumors. While biopsy is recommended, the optimal timing relative to ablation remains undefined. Pre-ablation biopsy may complicate ablation through hemorrhage, impaired target visualization, and potential tumor seeding. Post-cryoablation biopsy has been described in a small cohort of patients, but reproducibility has not been established. This study evaluated the diagnostic performance and clinical outcomes of renal mass biopsy performed immediately after cryoablation in a single session.
Methods:
This retrospective, single-center study included patients who underwent image-guided percutaneous cryoablation followed by immediate post-ablation core needle biopsy, performed at operator discretion, between December 2018 and April 2025. After active or passive thaw and probe removal, at least two 18-gauge core biopsy samples were obtained per lesion using a coaxial needle. Specimens were formalin-fixed and reviewed by pathology. Outcomes included specimen adequacy, histopathologic diagnosis, adverse events, imaging response, and tumor recurrence or seeding. Follow-up imaging and labs were performed at 3 and 6 or 9 months, then annually.
Results:
Twenty-six solid enhancing renal masses (mean size 2.5 cm, range 1.4-4.7 cm) in 24 patients were included. All biopsy specimens were diagnostic with histologic diagnoses including renal cell carcinoma (RCC, n = 19), oncocytoma (n = 6), and metanephric adenoma (n = 1), with RCC subtypes including clear cell, papillary, chromophobe, sarcomatoid, and mixed histology. Complications were limited to the immediate post-procedural period, with no delayed adverse events or chronic sequelae. All lesions demonstrated complete radiographic response on 3-month follow-up imaging. There were no cases of tumor recurrence or seeding observed over a median follow-up of 1,415 days.
Conclusion:
Immediate post-cryoablation renal mass biopsy is diagnostically reliable and may provide benefit in clinical practice.
