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[Can pharmaco-DSA of the kidney replace intraoperative rapid biopsy diagnosis?]
Question:
Can primary nephrectomy be performed without preliminary sample excision of the tumor if pharmaco-angiography of the kidney has demonstrated the typical tumor vascularization?
Material And Method:
To clarify this question in 32 patients with "displacing mass" of the kidney, verified in sonography and computer-tomography, or hematuria of unknown origin, we prospectively performed and additional pharmaco-angiography of the respective kidney.
Results:
In 18 patients with tumor vascularization in the pharmaco-angiography, intraoperatively we found 15 malignant renal cell carcinomas, 1 patient with transitional cell carcinoma of the renal pelvis, 1 leiomyosarcoma, and 1 high-differentiated tumor of only 2 cm in diameter with unclear dignity, which was treated by enucleation.
Conclusion:
In case of an intrarenal lesion of more than 3 cm in diameter and additional tumor vascularization seen in selective pharmaco-angiography, the kidney undoubtedly can be removed by primary nephrectomy without a preliminary sample excision to confirm the diagnosis. For tumors with a diameter of less than 3 cm and additional tumor-vascularization, the option should be enucleation. If there is a "tumor" without typical malignant vascularization, the exploration by sample excision should be performed. Depending on the histological result the tumor should be removed by enucleation or nephrectomy.
Insights
Primary nephrectomy is feasible for kidney tumors over 3 cm with typical vascularization, avoiding preliminary biopsies. Smaller tumors or those lacking typical vascularization require further diagnostic steps or enucleation.
Area of Science:
- Urology
- Radiology
- Oncology
Context:
- Renal masses present diagnostic challenges.
- Distinguishing benign from malignant renal tumors preoperatively is crucial for surgical planning.
- Pharmaco-angiography offers detailed vascular assessment of renal lesions.
Purpose:
- To evaluate the efficacy of primary nephrectomy without prior biopsy in renal tumors with characteristic vascularization identified by pharmaco-angiography.
- To establish guidelines for surgical management based on tumor size and vascular patterns.
Summary:
- Pharmaco-angiography identified typical tumor vascularization in 18 of 32 patients with renal masses.
- Primary nephrectomy was performed without preliminary biopsy in cases with lesions >3 cm and typical vascularization.
- Smaller tumors (<3 cm) with vascularization were enucleated, while those without typical vascularization underwent biopsy.
Impact:
- This approach can potentially streamline surgical treatment for renal cell carcinoma and other renal tumors.
- It may reduce the need for invasive diagnostic procedures, improving patient outcomes.
- Optimizes surgical strategy for renal masses, differentiating between nephrectomy and enucleation based on imaging and size.