Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience

• Published in: Academic radiology Vol. 26; no. 2; pp. 232 - 238
• Main Authors: Wasnik, Ashish P, Higgins, Ellen J, Fox, Giovanna A, Caoili, Elaine M, Davenport, Matthew S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2019
• Subjects: Ablation; Aged; Biopsy; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Catheter Ablation - methods; Cryosurgery - methods; Female; Humans; Image-Guided Biopsy - methods; Kidney - diagnostic imaging; Kidney - pathology; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Magnetic Resonance Imaging - methods; Male; Middle Aged; Outcome Assessment, Health Care; Quality; Recurrence; Renal mass; Tomography, X-Ray Computed - methods; Unnecessary Procedures; Recurrence; Renal mass; Biopsy; Ablation; Quality
• ISSN: 1076-6332; 1878-4046
• DOI: 10.1016/j.acra.2018.05.016

To determine the yield of routine image-guided core biopsy of renal cell carcinoma (RCC) thermal ablation zones.
Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant quality improvement effort. Routine core biopsy of RCC ablation zones was performed 2 months postablation from July 2003 to December 2014. Routine nicotinamide adenine dinucleotide staining was performed by specialized genitourinary pathologists to assess cell viability. The original purpose of performing routine postablation biopsy was to verify, in addition to imaging, whether the mass was completely treated. Imaging was stratified as negative, indeterminate, or positive for viable malignancy. Histology was stratified as negative, indeterminate, positive, or nondiagnostic for viable malignancy. Histology results were compared to prebiopsy imaging findings.
Routine ablation zone biopsy was performed after 50% (146/292) of index ablations (24 cryoablations, 122 radiofrequency ablations), and postablation imaging was performed more often with multiphasic computed tomography than magnetic resonance imaging (100 vs 46, p < 0.0001). When imaging was negative (n = 117), biopsy added no additional information (92% [n = 108] negative, 0.9% [n = 1] indeterminate, 7% [n = 8] nondiagnostic). When imaging was indeterminate (n = 19), 11% (n = 2) of biopsies had viable RCC and 89% (n = 17) were negative. When imaging was positive, biopsy detected viable neoplasm in only 10% (1/10) of cases; 80% (8/10) were negative and 10% (1/10) were nondiagnostic.
Routine biopsy of renal ablation zones to validate postablation imaging results was not value-added and therefore was discontinued at the study institution.