Renal cell carcinoma diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.

Diagnostic Study of Choice

A needle biopsy should always be performed when the finding of a renal mass is detected on imaging.

Needle Biopsy

Needle biopsy should always be performed when the finding of a renal mass is detected on imaging. CT or MRI guided needle biopsy distinguishes between different subgroups of renal cell carcinoma and identifies management: active surveillance, surgery, or medical therapy.[1] The sensitivity and specificity of needle biopsy are very high. The rate of biopsy-related complications, including biopsy-associated seeding, is considered very low.[1]

Histopathological Findings in Renal Cell Carcinoma[2][3]
Type Characteristic Features
Conventional (Clear Cell) *Nests of tumor cells that are compacted near each other
*Clear cytoplasm
*Delicate vasculature that separates the cytoplasm
*Varying architectural patterns, such as solid, alveolar, or acinar
Papillary *Papillae, tubulopapillae, and tubules that are present in differing percentages
*Type I generally has papillae lined with only 1 layer of cancer cells, pale cytoplasm, and small oval nuclei
*Type II generally are more heterogeneous tumors that have pseudostratification with large, spherical nuclei and distinct nucleoli
Chromophobe *Large polygonal cells
*Finely reticulated cytoplasm that may be eosinophilic
*Distinct cell borders
*Atypical nuclei with perinuclear halo
Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.N Engl J Med. 2005; 353:2477-90 & Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet. 2009; 373(9669):1119-32

References

  1. 1.0 1.1 Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH; et al. (2013). "Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline". J Urol. 190 (2): 407–16. doi:10.1016/j.juro.2013.04.121. PMID 23665399.
  2. Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  3. Rini BI, Campbell SC, Escudier B (2009). "Renal cell carcinoma". Lancet. 373 (9669): 1119–32. doi:10.1016/S0140-6736(09)60229-4. PMID 19269025.

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