Renal oncocytoma other diagnostic studies: Difference between revisions
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Renal mass biopsy may be helpful in the diagnosis of renal oncocytoma. However, distinguishing between oncocytoma and RCC by biopsy is difficult. Since this method only reserved for patients who are at high risk for an operation like very elderly or extremely sick patients. <ref name="HaiflerCopel2012">{{cite journal|last1=Haifler|first1=Miki|last2=Copel|first2=Laurian|last3=Sandbank|first3=Judith|last4=Lang|first4=Erez|last5=Raz|first5=Orit|last6=Leibovici|first6=Dan|last7=Lindner|first7=Arie|last8=Zisman|first8=Amnon|title=Renal oncocytoma—are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis|journal=Urologic Oncology: Seminars and Original Investigations|volume=30|issue=4|year=2012|pages=362–368|issn=10781439|doi=10.1016/j.urolonc.2009.11.024}}</ref> | Renal mass biopsy may be helpful in the diagnosis of renal oncocytoma. However, distinguishing between oncocytoma and RCC by biopsy is difficult. Since this method only reserved for patients who are at high risk for an operation like very elderly or extremely sick patients. <ref name="HaiflerCopel2012">{{cite journal|last1=Haifler|first1=Miki|last2=Copel|first2=Laurian|last3=Sandbank|first3=Judith|last4=Lang|first4=Erez|last5=Raz|first5=Orit|last6=Leibovici|first6=Dan|last7=Lindner|first7=Arie|last8=Zisman|first8=Amnon|title=Renal oncocytoma—are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis|journal=Urologic Oncology: Seminars and Original Investigations|volume=30|issue=4|year=2012|pages=362–368|issn=10781439|doi=10.1016/j.urolonc.2009.11.024}}</ref> | ||
Complications of renal mass biopsy include:<ref name="LaneSamplaski2008">{{cite journal|last1=Lane|first1=Brian R.|last2=Samplaski|first2=Mary K.|last3=Herts|first3=Brian R.|last4=Zhou|first4=Ming|last5=Novick|first5=Andrew C.|last6=Campbell|first6=Steven C.|title=Renal Mass Biopsy—A Renaissance?|journal=Journal of Urology|volume=179|issue=1|year=2008|pages=20–27|issn=0022-5347|doi=10.1016/j.juro.2007.08.124}}</ref><ref name="HaraMiyake2001">{{cite journal|last1=Hara|first1=Isao|last2=Miyake|first2=Hideaki|last3=Hara|first3=Shoji|last4=Arakawa|first4=Soichi|last5=Hanioka|first5=Keisuke|last6=Kamidono|first6=Sadao|title=Role of Percutaneous Image-Guided Biopsy in the Evaluation of Renal Masses|journal=Urologia Internationalis|volume=67|issue=3|year=2001|pages=199–202|issn=0042-1138|doi=10.1159/000050987}}</ref><ref>{{Cite journal | Complications of renal mass biopsy include:<ref name="LaneSamplaski2008">{{cite journal|last1=Lane|first1=Brian R.|last2=Samplaski|first2=Mary K.|last3=Herts|first3=Brian R.|last4=Zhou|first4=Ming|last5=Novick|first5=Andrew C.|last6=Campbell|first6=Steven C.|title=Renal Mass Biopsy—A Renaissance?|journal=Journal of Urology|volume=179|issue=1|year=2008|pages=20–27|issn=0022-5347|doi=10.1016/j.juro.2007.08.124}}</ref><ref name="HaraMiyake2001">{{cite journal|last1=Hara|first1=Isao|last2=Miyake|first2=Hideaki|last3=Hara|first3=Shoji|last4=Arakawa|first4=Soichi|last5=Hanioka|first5=Keisuke|last6=Kamidono|first6=Sadao|title=Role of Percutaneous Image-Guided Biopsy in the Evaluation of Renal Masses|journal=Urologia Internationalis|volume=67|issue=3|year=2001|pages=199–202|issn=0042-1138|doi=10.1159/000050987}}</ref><ref>{{Cite journal | ||
| author = [[P. W. Ralls]], [[J. A. Barakos]], [[E. M. Kaptein]], [[P. E. Friedman]], [[G. Fouladian]], [[W. D. Boswell]], [[J. Halls]] & [[S. G. Massry]] | | author = [[P. W. Ralls]], [[J. A. Barakos]], [[E. M. Kaptein]], [[P. E. Friedman]], [[G. Fouladian]], [[W. D. Boswell]], [[J. Halls]] & [[S. G. Massry]] | ||
Revision as of 15:53, 30 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]
hOverview
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
Biopsy:
Renal mass biopsy may be helpful in the diagnosis of renal oncocytoma. However, distinguishing between oncocytoma and RCC by biopsy is difficult. Since this method only reserved for patients who are at high risk for an operation like very elderly or extremely sick patients. [1]
Complications of renal mass biopsy include:[2][3][4][5][6]
- Perirenal hemorrhage
- Pneumothorax ( during biopsy of upper pole tumors)
- Tumor seeding
Needle biopsy of the tumor can be a useful strategy to diagnose oncocytoma in the very elderly or very sick patient with a renal tumor. There have been cases reported in which patients with large bilateral and unresectable renal oncocytomas have been observed for many years without showing distinct tumoral progression. Such observational treatment may be entirely appropriate for patients at poor operative risk because of extensive comorbidities
Renal mass biopsy (RMB) was abandoned due to several shortcomings of the procedure. It was claimed that RMB may be inaccurate due to sampling errors and heterogeneity of renal masses. As stated above, on some occasions it is difficult to distinguish between oncocytoma, cRCC, and oncocytic papillary RCC. In addition, the “hybrid” nature of some tumors may be missed by RMB. Despite these limitations, the positive and negative predictive values of RMB are quite high (95.7% and 82%, respectively). Similarly, sensitivity and specificity were also high (92.1% and 89.7%, respectively). Another concern raised in the past was the pretty high complication rate [80]. Recent studies demonstrated less than 5% minor complications, mostly peri-renal hemorrhage [80–83], however only 1% to 2% required observation or blood transfusion [84]. High needle approach to upper pole tumors may pierce through the pleura in 14% to 29% [85], but clinically evident pneumothorax occurs in less than 1% of cases [85]. Tumor seeding was a feared complication of RMB, but its reported incidence is less than 0.01% and no case was reported in the last 15 years [86]. Evidently, RMB has some disadvantages, but the risk of overtreating patients by avoiding RMB became recently a discussed issue that received new interest. Reluctance of patients to undergo and physicians to prescribe nonsurgical treatment for renal masses without definitive tissue diagnosis could be alleviated by RMB. Technological innovations (e.g., introducers, higher quality imaging) will probably make RMB safer and more accurate.
Core needle biopsies are increasingly used in the diagnosis of renal masses (Figure 3). Because 20–45% of small renal masses are ultimately found to be benign, active surveillance is an option for many patients (38, 39). The diagnostic accuracy of renal mass biopsy remains somewhat controversial, however. Individual groups have reported up to 80% diagnostic rate from renal mass biopsy, with the ability to provide subtype and nuclear grade in the majority of diagnostic biopsies (40). Unfortunately, oncocytic lesions can be especially troublesome in renal mass biopsy, as interpreting only a limited sampling of tumor may not be representative of the entire lesion. A meta-analysis of 205 oncocytic renal mass biopsies from 2017 showed that the positive predictive value for a diagnosis of oncocytoma on renal mass biopsy was 67% with significant heterogeneity and wide confidence interval, indicating that the diagnostic accuracy varies greatly between studies and, by extrapolation, between pathologists (41). For renal mass biopsies of oncocytic neoplasms, there is a split among urologic pathologists as to whether it is preferable to issue an outright diagnosis of oncocytoma (when features are typical in the biopsy sample) or to use more general terminology, such as “oncocytic neoplasm,” with comment that the features are compatible with oncocytoma (5). In the context that morphologic and immunohistochemical features are largely compatible with oncocytoma, yet in which there are minor equivocal features, such as variation in cell size or slight nuclear irregularity, it is also reasonable to utilize a borderline diagnostic category expressing uncertainty between oncocytoma and eosinophilic variant chromophobe renal cell carcinoma. In this setting, immunohistochemical staining may also be helpful. Although CK7 staining may not be beyond the expected level of oncocytoma, findings such as negative vimentin staining and positive KIT staining generally argue against other considerations, such as papillary or clear cell renal cell carcinoma with eosinophilic cells. Since chromophobe renal cell carcinoma, especially the eosinophilic variant, is also generally regarded as a less aggressive tumor subtype, this can facilitate appropriate management in patients who are candidates for nonsurgical treatment (42). Conversely, if nuclear or cytologic features are inconsistent with oncocytoma (non-degenerative atypia, nuclear membrane irregularity, or perinuclear clearing), a diagnosis of eosinophilic variant of chromophobe renal cell carcinoma may be favored.
References
- ↑ Haifler, Miki; Copel, Laurian; Sandbank, Judith; Lang, Erez; Raz, Orit; Leibovici, Dan; Lindner, Arie; Zisman, Amnon (2012). "Renal oncocytoma—are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis". Urologic Oncology: Seminars and Original Investigations. 30 (4): 362–368. doi:10.1016/j.urolonc.2009.11.024. ISSN 1078-1439.
- ↑ Lane, Brian R.; Samplaski, Mary K.; Herts, Brian R.; Zhou, Ming; Novick, Andrew C.; Campbell, Steven C. (2008). "Renal Mass Biopsy—A Renaissance?". Journal of Urology. 179 (1): 20–27. doi:10.1016/j.juro.2007.08.124. ISSN 0022-5347.
- ↑ Hara, Isao; Miyake, Hideaki; Hara, Shoji; Arakawa, Soichi; Hanioka, Keisuke; Kamidono, Sadao (2001). "Role of Percutaneous Image-Guided Biopsy in the Evaluation of Renal Masses". Urologia Internationalis. 67 (3): 199–202. doi:10.1159/000050987. ISSN 0042-1138.
- ↑ P. W. Ralls, J. A. Barakos, E. M. Kaptein, P. E. Friedman, G. Fouladian, W. D. Boswell, J. Halls & S. G. Massry (1987). "Renal biopsy-related hemorrhage: frequency and comparison of CT and sonography". 11 (6): 1031–1034. PMID 3316324. Unknown parameter
|Journal=ignored (|journal=suggested) (help); Unknown parameter|month=ignored (help) - ↑ Hopper, K D; Yakes, W F (1990). "The posterior intercostal approach for percutaneous renal procedures: risk of puncturing the lung, spleen, and liver as determined by CT". American Journal of Roentgenology. 154 (1): 115–117. doi:10.2214/ajr.154.1.2104692. ISSN 0361-803X.
- ↑ Silverman, Stuart G.; Gan, Yu Unn; Mortele, Koenraad J.; Tuncali, Kemal; Cibas, Edmund S. (2006). "Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy". Radiology. 240 (1): 6–22. doi:10.1148/radiol.2401050061. ISSN 0033-8419.