Percutaneous Biopsy Accurately Diagnoses Urothelial Carcinoma

Technique provides a tissue diagnosis in 88% of cases, according to a study.
Technique provides a tissue diagnosis in 88% of cases, according to a study.

SAN DIEGO—Percutaneous biopsy is a safe and effective way to diagnose upper tract urothelial carcinoma, providing a tissue diagnosis in 88% of cases, researchers reported at the Society for Interventional Radiology annual meeting.

Steven Huang, MD, and colleagues at MD Anderson Cancer Center in Houston, studied 25 upper tract lesions in 24 patients that were percutaneously biopsied. Of the 25 lesions, 13 (52%) were masses infiltrating the renal parenchyma (mean 5.4 cm), 7 (28%) were cases of urothelial wall thickening (mean 0.8 cm), and 5 were filling defects within the renal pelvis or calyx (mean 2.7 cm).

Percutaneous biopsy enabled a definitive diagnosis of urothelial carcinoma in 22 of 25 lesions (88%). Biopsy characterized all infiltrative masses and filling defects, but only 57% of cases of urothelial wall thickening. Open biopsy confirmed urothelial carcinoma in the 3 cases of non-diagnostic percutaneous biopsies.

One patient experienced a single procedural complication of pain/hematuria that required overnight hospitalization. Computed tomography follow-up was available for 21 patients at a median of 9.7 months. Three patients (14.3%) experienced recurrence in the nephrectomy bed 5.6, 9.7, and 29.0 months following biopsy. None of these were attributable to tract seeding, “as recurrence was remote from the biopsy site,” the authors noted in their study abstract.

“While case reports cite a risk of tract seeding [from percutaneous procedures], no cases of recurrence were definitely attributable to percutanteous biopsy,” the investigators concluded. “Thus, for upper tract urothelial lesions, which are amenable to endoscopic biopsy, percutaneous biopsy is a safe and effective technique.”

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