The role of percutaneous fine needle aspiration biopsy in the management of small renal masses without chance of nephron
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UROLOGY - ORIGINAL PAPER
The role of percutaneous fine needle aspiration biopsy in the management of small renal masses without chance of nephron‑sparing surgery Wei Tong1 · Xianwen Lin2 · Yizhi Xu3 · Yi Yan1,4,5 Received: 21 May 2020 / Accepted: 27 June 2020 © Springer Nature B.V. 2020
Abstract Purpose We seek to confirm the safety and efficacy of percutaneous fine needle aspiration biopsy (FNAB) for small renal masses (SRMs) without chance of nephron-sparing surgery (NSS). Methods Between 2015 and 2018, 169 consecutive patients with SRMs treated in two medical centers were enrolled in the study retrospectively. All patients were evaluated to be candidates of radical nephrectomy (RN) at the initial evaluation preoperatively and they would receive the second evaluation in operation to decide the ultimate surgical regimen. Patients were divided into two groups according to FNAB. Results 169 patients met inclusion criteria were enrolled in the finial study. The median follow-up of was 35 months (ranges from 23 to 49 months) from the first diagnosis. 83 patients received FNAB before surgery, and the other 86 patients underwent surgery immediately. The initial success rate of FNAB was 91.6% (76/83) and the rate of accuracy in identifying malignancies was 100%. 15 (18.1%) of 83 patients developed different levels of complications. 15 (18.1%) were diagnosed as benign tumors by FNAB. The initial success rate was just 50% for cystic SRMs. Complicated cystic SRMs account for 5.9% of all with a 50% benignity rate. The FNAB group had a significant lower ratio of RN than non-FNAB group (74.7% vs. 93%, p = 0.001, Pearson Chi-square test). Conclusion FNAB is safe and effective for SRMs without chance of NSS, and it could significantly reduce unnecessary RN. Keywords Small renal masses · Percutaneous renal biopsy · Radical nephrectomy · Nephron-sparing surgery · Active surveillance * Yi Yan [email protected]
Introduction
Wei Tong [email protected]
With the popularization of imaging examination and health concepts, small renal masses (SRMs; ≤ 4 cm in dimension) represent a heterogeneous group of tumors that have rapidly risen in incidence in recent decades [1, 2]. Immediate surgery (radical nephrectomy or nephron-sparing surgery) without pre-operative pathologic result is still the mainstream treatment for SRMs. To be confirmed as safe and effective as radical nephrectomy (RN), nephron-sparing surgery (NSS) has been recommended as standard surgery for SRMs [3]. It could eradicate lesions and reserve the diseased kidney no matter what pathological natures of masses are. However, there are still a part of SRMs that could not be treated by NSS because of complexity of structure and high technical difficulty. To evaluate perioperative outcome and screen potential candidates of NSS, the R.E.N.A.L. nephrometry score system has been widely used for SRMs
Xianwen Lin [email protected] Yizhi Xu [email protected] 1
Department of Urology, Chongqing General Hospital, Chongqing, China
2
Department of Gerontolog
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