Percutaneous renal mass biopsy at Siriraj Hospital: A retrospective study

Background: Limited data on renal mass biopsies are available from Asian regions, most specifically from developing countries. Objective: To assess the diagnostic yield of percutaneous renal mass biopsy, factors related to diagnostic yield, and immediate complications associated with the biopsy procedure. Methodology: A single-center retrospective observational study included 144 patients who underwent 146 consecutive imaging-guided renal mass biopsies from January 2018 to June 2023. The biopsy outcomes were classified into diagnostic and nondiagnostic groups. Patient characteristics, renal mass variables, and biopsy procedure-related variables were compared to assess their significant associations with biopsy outcome. Multivariate logistic regression analysis was performed to identify an independent predictor of diagnostic biopsy. Results: The initial biopsy result was diagnostic in 91.1% (133/146) of patients, out of which 15% were benign and 85% malignant lesions. Repeat biopsy was performed in 3/13 initial nondiagnostic cases, yielding 100% diagnostic results and an overall diagnostic yield of 93.2%. The renal mass composition, size, and the number of core biopsies were significantly associated with diagnostic biopsy outcome (p value < 0.05). The number of core biopsies significantly predicted the diagnostic biopsy results according to multivariate regression analysis (OR=0.533, CI 0.299–0.952, p=0.033). The concordance of biopsy results with available surgical histopathology reports was 92.3% (24/26), after excluding the two surgically resected specimens from initial non-diagnostic results. The immediate complications were documented in 14.4% (21/146) of patients with 11.6% mild adverse events (perinephric hematoma, perilesional and subcapsular hematoma) and 2.7% severe adverse events (expanding hematoma/ active bleeding) according to the Society of Interventional Radiology adverse event classification. Conclusion: Considering its high accuracy and low complication rate, percutaneous renal mass biopsy can play an important role in risk stratification and guide appropriate management plans in patients with renal masses, thereby avoiding overtreatment and preventing complications associated with surgery.研究背景：目前亚洲地区，尤其是发展中国家，关于肾脏肿块活检的相关数据较为匮乏。 研究目的：评估经皮肾肿块活检（percutaneous renal mass biopsy）的诊断效能、与诊断效能相关的影响因素，以及该活检操作相关的即刻并发症。 研究方法：本研究为单中心回顾性观察性研究，纳入2018年1月至2023年6月期间接受146例连续影像引导下肾脏肿块活检的144例患者。将活检结局分为诊断阳性组与诊断阴性组，比较患者基线特征、肾脏肿块相关变量及活检操作相关变量，以明确其与活检结局的显著相关性；采用多因素logistic回归分析确定影响活检诊断效能的独立预测因子。 研究结果：初始活检的诊断阳性率为91.1%（133/146），其中良性病变占15%，恶性病变占85%。13例初始活检诊断阴性的患者中，3例接受了重复活检，重复活检均获得诊断阳性结果，总体诊断阳性率升至93.2%。肾脏肿块的成分、大小及核心针活检取材数量均与活检诊断结局显著相关（P<0.05）。多因素回归分析显示，核心针活检取材数量是活检诊断结局的独立预测因子（OR=0.533，95%CI：0.299~0.952，P=0.033）。排除2例初始活检诊断阴性的手术切除标本后，活检结果与后续手术病理报告的符合率为92.3%（24/26）。根据介入放射学会（Society of Interventional Radiology）不良事件分级标准，14.4%（21/146）的患者出现了即刻并发症，其中轻度不良事件占11.6%（表现为肾周血肿、病灶周围血肿及包膜下血肿），重度不良事件占2.7%（表现为进行性血肿/活动性出血）。 研究结论：经皮肾肿块活检具有诊断准确率高、并发症发生率低的优势，可在肾脏肿块患者的风险分层中发挥重要作用，指导制定个体化治疗方案，从而避免过度治疗，并降低手术相关并发症的发生风险。