Presentation Authors: Valeria Tringali*, Deliu Victor Matei, Giuseppe Renne, Paolo Della Vigna, Ottavio de Cobelli, Milano, Italy
Introduction: The standard of care for renal masses and localized renal cancer is still debated. Both nephron sparing approaches (surgery (NSS) or percutaneous thermal ablation (PTA)) or radical nephrectomy (RN) bear the risks of postoperative complications, while in the case of benign lesions, they are useless or even harmful. On the contrary, active surveillance (AS) carries the risk of progression. Although percutaneous needle-renal biopsy (PNRB) seems appropriate to guide therapeutic decision, it is still far from being widely accepted and diffused.
Methods: We retrospectively reviewed our pathology archives of operated and biopsied renal masses from 1999 to 2017 and considered those having had a benign pathology.
Results: 1281 kidney surgery procedures were performed for radiologic suspicious malignant renal masses. Of these, 118 (9.2%) resulted in benign lesions at final pathology. 71 of them underwent NS-surgery, scilicet 15.8% of all NSS, while 47 underwent RN (5.7% of all RN). Our institution began to perform PNRB in 1999, with a steep increase in the number of procedures per year in the last decade, and a low rate of adverse effects. Biopsy result was inconclusive in 8 (6.8%) of the benign cases, requiring new biopsy. Benign versus malignant discordance between biopsy and surgery was seen in 4 cases. Therapy of benign lesions according to the biopsy status is reported in Tab. 1.Time-evolution of overall therapeutic approaches is shown in Graph 1.
Conclusions: Renal biopsy allows an appropriate management of benign lesions by avoiding overtreatment. It has a favorable tolerability profile, low side effects and complication rates. Moreover, the positive predictive value is quite high. As adequacy of biopsy specimen and pathological diagnosis improve, the only limitations to a systematic utilization of renal biopsy might be those eloquent radiologic aspects that are highly reliable on differentiating benign from non-benign lesions.