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Cystic features, contrast enhancement predict risk of nondiagnostic findings in renal mass biopsy

31 May 2019

A recent study has shown that procedural complications following percutaneous core renal mass biopsy are uncommon even with low serum platelets, a mildly increased international normalized ratio (INR) or when patients are on aspirin.

Additionally, the risk of nondiagnostic findings is independently predicted by cystic features, hypo-enhancement on imaging, a smaller mass diameter and a longer skin-to-tumour distance.

A total of 1,155 biopsies were performed in 965 patients, of whom 24 (2.2 percent) had procedural complications, including five (0.4 percent) with major complications (Clavien 3a). None of the patients had tumour seeding of the biopsy tract.

The following factors did not correlate with the risk of complication (p=0.06–0.53): age, gender, body mass index, Charlson comorbidity index, smoking, mass diameter, nephrometry score, number of cores and prior biopsy.

Complications were not elevated for patients taking aspirin (p=0.16) or those with low platelets (25,000–160,000/μl blood; p=0.07) or a mildly increased INR (1.2–2.0; p=0.50). No increase in complication risk was seen during the initial 50 cases of a radiologist (p=0.35) or when a trainee was present (p=0.12).

Of the biopsies, 14.6 percent presented with nondiagnostic findings, which were independently associated with cystic features (p<0.001), contrast enhancement (p=0.002), mass diameter (p=0.02) and skin-to-mass distance (p=0.049), but not with radiologist experience (p=0.23). Previous nondiagnostic biopsy did not correlate with an elevated nondiagnostic rate on subsequent attempts (19.2 percent vs 14.2 percent; p=0.23).

In this study, the authors reviewed core renal mass biopsies from 2000 to 2017 and used the Clavien-Dindo system to grade complications at 30 days. They also performed univariate and multivariate analyses to examine associations between clinical characteristics and the risk of complications or nondiagnostic findings.

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Most Read Articles
6 days ago
In patients with type 2 diabetes, obesity may be protective against vision-threatening diabetic retinopathy, a recent Korea study has shown.
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The aromatase inhibitor anastrozole shows promise in the treatment of children with congenital adrenal hyperplasia, reducing bone age advancement without adversely affecting bone mineral density and visceral adipose tissue, as shown in a recent study.
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