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Fine needle aspiration plus biopsy may improve diagnosis of renal masses

15 May 2017

Fine needle aspiration with core needle biopsy is associated with improved diagnostic yield when sampling renal masses compared with fine needle aspiration alone, according to a study. However, it has subtyping potential comparable to that of core needle biopsy only.

Researchers conducted a single institution, retrospective study of 342 cases from 2001 to 2015 with small and large renal masses (≤4 cm and >4cm). They analysed diagnostic and concordance rates, as well as the impact on management.

Adequacy rates for fine needle aspiration only was 21 percent, for core needle biopsy only 12 percent and for fine needle aspiration plus core needle biopsy 8 percent (p<0.026 for aspiration vs aspiration plus biopsy).

In the aspiration plus biopsy group, adding aspiration to biopsy reduced the inadequacy rate from 23 to 8 percent (total reduction rate [TRR], 15 percent) even as adding biopsy to aspiration reduced the inadequacy rate from 27 to 8 percent (TRR, 19 percent), corresponding to 32 cases (9.3 percent). Rapid on-site examination provided a 22.5-percent improvement in fine needle aspiration adequacy rates.

In this cohort, 30 percent of aspiration only, 5 percent on biopsy only and 12 percent of aspiration plus biopsy could not be subtyped (p<0.0001 for aspiration vs biopsy; p<0.0127 for aspiration vs aspiration plus biopsy; and p=0.06 for biopsy vs aspiration plus biopsy).

There was a 99-percent diagnostic concordance rate with surgical resection. Using a concurrent procedure, conversion of an inadequate specimen to an adequate one affected treatment in at least 29 of 32 patients.

The study was limited by its retrospective design and the accuracy measurement based on surgical intervention.

Fine needle aspiration with and without concurrent core needle biopsy is a minimally invasive method used for diagnosis and assisting in the management of renal masses, researchers said.

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