Diagnostic accuracy of core biopsies of renal masses: Experience in a real-life setting from a tertiary center

• Published in: Annals of diagnostic pathology Vol. 55; p. 151830
• Main Authors: Altay, Ali Yilmaz, Karatay, Huseyin, Bakir, Baris, Erdem, Selcuk, Buyuk, Melek, Ozcan, Faruk, Kilicaslan, Isin, Ozluk, Yasemin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2021
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy, Large-Core Needle - methods; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - pathology; Diagnosis, Differential; Epithelial Cells - pathology; Female; Humans; Immunohistochemistry; Kidney - cytology; Kidney - pathology; Kidney Neoplasms - diagnosis; Kidney Neoplasms - pathology; Male; Middle Aged; Renal cell carcinoma; Renal core biopsy; Retrospective Studies; Small renal mass; Immunohistochemistry; Renal core biopsy; Small renal mass; Renal cell carcinoma
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2021.151830

To document and analyze diagnostic accuracy of renal core biopsy (RCB), its diagnostic correlation with resection specimens, and to question the need for immunohistochemistry (IHC) in the preoperative diagnosis of renal masses.
RCBs performed at a reference center between 2007 and 2017 were included. Pathological, clinical, and radiological data were obtained from medical records.
Among 302 biopsies included in this study, 274 (90.7%) were diagnostic. Two hundred sixty-six were neoplastic and 179 were of primary renal origin. The most common secondary neoplasms were hematolymphoid (n = 35) and metastatic (n = 17). Sixty-nine tumors were classified as small renal masses (SRMs) (≤4 cm in diameter) and 53 of them were malignant. Nephrectomy was performed in 58 patients. Overall diagnostic accuracy between resections and RCBs was 88.7%. IHC was performed in 160 (53%) cases. In 15 of those, a definite diagnosis could not be rendered. Renal cell origin and subtype were determined by histomorphology alone in 81 and 75 cases, respectively. Sixty primary neoplasms of renal cell origin required IHC for diagnosis.
RCB is a safe and highly accurate method for the diagnosis of both primary and secondary renal neoplasms. IHC is mostly required for the diagnosis of secondary tumors. Histomorphology is still the primary diagnostic tool, highly dependent on the experience of the surgical pathologist.
•Core biopsy from renal masses found to be a reliable diagnostic tool with high diagnostic rates.•Benign tumors were more frequent in masses less than 4 cm in diameter.•Immunohistochemistry was required mostly for the diagnosis of secondary renal tumors.