NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Preoperative Biopsy of Renal Lesions Less Than 4.0 cm Decreases Nephrectomies Performed For Benign Tumors
Jai R. Eswara, BA, Brian H. Eisner, MD, Scott E. Hunter, BA, Anthony M. Samir, MD, Peter F. Hahn, MD, Michael M. Maher, MD, Debra A. Gervais, MD, Peter R. Mueller, MD, Francis J. McGovern, MD.
Massachusetts General Hospital, Boston, MA,

Background: Up to 20% of small solid renal lesions are benign. We reviewed data from radical and partial nephrectomies to determine whether preoperative renal biopsy decreased the incidence of benign surgical pathology for solid renal lesions less than or equal to 4 cm in diameter.
Methods: A retrospective review of electronic hospital records was performed to identify all radical and partial nephrectomies performed by a single surgeon for solid renal tumors less than 4 cm in maximal diameter between October 1993 and October 2005. Focal renal biopsies were performed at the surgeonís discretion under CT or ultrasound guidance. Core biopsies were performed with 15-18 gauge cutting needles (Temno, Cardinal Health Systems) and FNAs were performed with 20-23 gauge Chiba needles (Cook, Bloomington, IN). Institutional review board approval was obtained prior to this study.
Results: 129 total operations were identified. 44 patients (34%) underwent preoperative renal lesion biopsy. Mean tumor diameter (2.8 cm in biopsy group and 2.5 cm in no-biopsy group) was not statistically different (student's t-test p < 0.10). A statistically significant decrease in benign surgical pathology was seen in the group that underwent preoperative biopsy when compared to the group that did not undergo preoperative biopsy (4.5% versus 20%, chi-square test p < 0.02). There was also a stastically significant decrease in nephrectomy for oncocytoma between these 2 groups (0% versus 16.5%, t-test p < 0.0001). For renal biopsy (core with FNA), diagnostic yield was 95.7%, diagnostic accuracy was 97.7%, sensitivity for malignancy was 97.7% and specificity was 100%.
Conclusions: A statistically significant decrease in benign pathology was demonstrated among patients who underwent preoperative biopsy for solid renal lesions less than 4 cm in diameter. Preoperative renal biopsy may prevent unnecessary surgical or ablative procedures in patients with small solid renal lesions.


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