Evaluation of patients referred for percutaneous ablation of renal tumors

Importance of a preprocedural diagnosis

Kemal Tuncali, Eric VanSonnenberg, Sridhar Shankar, Koenraad J. Mortele, Edmund S. Cibas, Stuart G. Silverman

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

OBJECTIVE. Percutaneous ablation of renal cell carcinoma has the potential to be as effective as partial nephrectomy. Because the entire tumor cannot be examined at pathology, diagnosis relies solely on imaging and percutaneous biopsy. Diagnoses of cancer have been rendered using imaging alone in some clinical trials of percutaneous ablation. If these trials inadvertently included benign masses, the efficacy of ablation was overestimated. Therefore, we sought to determine the prevalence of benign masses in a population of patients referred for percutaneous tumor ablation of presumed renal cell carcinoma. SUBJECTS AND METHODS. Twenty-seven patients were referred by urologists for MRI-guided cryotherapy of suspected renal cell carcinoma. Renal masses ranged from 1.0 to 4.6 cm (mean, 2.2 cm) in diameter. The CT, MRI, and percutaneous biopsy findings were tabulated and compared with surgical and imaging follow-up. RESULTS. Ten patients (37%) had a benign renal mass, including three angiomyolipomas, that had no evidence of fat on CT or MRI. Three masses were proven benign by biopsy, three by imaging, and four by a combination of biopsy and imaging. The masses in the remaining 17 patients were ablated. Biopsy revealed malignant cells in 10, suspicious cells in four, and atypical cells in two; one was nondiagnostic. CONCLUSION. A substantial percentage of patients referred for percutaneous ablation of renal tumors had benign masses. If CT or MRI alone cannot be used to diagnose a benign entity, patients should undergo a biopsy before the treatment session.

Original languageEnglish (US)
Pages (from-to)575-582
Number of pages8
JournalAmerican Journal of Roentgenology
Volume183
Issue number3
DOIs
StatePublished - Jan 1 2004

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Kidney
Biopsy
Renal Cell Carcinoma
Neoplasms
Angiomyolipoma
Cryotherapy
Nephrectomy
Fats
Clinical Trials
Pathology
Population
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Evaluation of patients referred for percutaneous ablation of renal tumors : Importance of a preprocedural diagnosis. / Tuncali, Kemal; VanSonnenberg, Eric; Shankar, Sridhar; Mortele, Koenraad J.; Cibas, Edmund S.; Silverman, Stuart G.

In: American Journal of Roentgenology, Vol. 183, No. 3, 01.01.2004, p. 575-582.

Research output: Contribution to journalArticle

Tuncali, Kemal ; VanSonnenberg, Eric ; Shankar, Sridhar ; Mortele, Koenraad J. ; Cibas, Edmund S. ; Silverman, Stuart G. / Evaluation of patients referred for percutaneous ablation of renal tumors : Importance of a preprocedural diagnosis. In: American Journal of Roentgenology. 2004 ; Vol. 183, No. 3. pp. 575-582.
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abstract = "OBJECTIVE. Percutaneous ablation of renal cell carcinoma has the potential to be as effective as partial nephrectomy. Because the entire tumor cannot be examined at pathology, diagnosis relies solely on imaging and percutaneous biopsy. Diagnoses of cancer have been rendered using imaging alone in some clinical trials of percutaneous ablation. If these trials inadvertently included benign masses, the efficacy of ablation was overestimated. Therefore, we sought to determine the prevalence of benign masses in a population of patients referred for percutaneous tumor ablation of presumed renal cell carcinoma. SUBJECTS AND METHODS. Twenty-seven patients were referred by urologists for MRI-guided cryotherapy of suspected renal cell carcinoma. Renal masses ranged from 1.0 to 4.6 cm (mean, 2.2 cm) in diameter. The CT, MRI, and percutaneous biopsy findings were tabulated and compared with surgical and imaging follow-up. RESULTS. Ten patients (37{\%}) had a benign renal mass, including three angiomyolipomas, that had no evidence of fat on CT or MRI. Three masses were proven benign by biopsy, three by imaging, and four by a combination of biopsy and imaging. The masses in the remaining 17 patients were ablated. Biopsy revealed malignant cells in 10, suspicious cells in four, and atypical cells in two; one was nondiagnostic. CONCLUSION. A substantial percentage of patients referred for percutaneous ablation of renal tumors had benign masses. If CT or MRI alone cannot be used to diagnose a benign entity, patients should undergo a biopsy before the treatment session.",
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N2 - OBJECTIVE. Percutaneous ablation of renal cell carcinoma has the potential to be as effective as partial nephrectomy. Because the entire tumor cannot be examined at pathology, diagnosis relies solely on imaging and percutaneous biopsy. Diagnoses of cancer have been rendered using imaging alone in some clinical trials of percutaneous ablation. If these trials inadvertently included benign masses, the efficacy of ablation was overestimated. Therefore, we sought to determine the prevalence of benign masses in a population of patients referred for percutaneous tumor ablation of presumed renal cell carcinoma. SUBJECTS AND METHODS. Twenty-seven patients were referred by urologists for MRI-guided cryotherapy of suspected renal cell carcinoma. Renal masses ranged from 1.0 to 4.6 cm (mean, 2.2 cm) in diameter. The CT, MRI, and percutaneous biopsy findings were tabulated and compared with surgical and imaging follow-up. RESULTS. Ten patients (37%) had a benign renal mass, including three angiomyolipomas, that had no evidence of fat on CT or MRI. Three masses were proven benign by biopsy, three by imaging, and four by a combination of biopsy and imaging. The masses in the remaining 17 patients were ablated. Biopsy revealed malignant cells in 10, suspicious cells in four, and atypical cells in two; one was nondiagnostic. CONCLUSION. A substantial percentage of patients referred for percutaneous ablation of renal tumors had benign masses. If CT or MRI alone cannot be used to diagnose a benign entity, patients should undergo a biopsy before the treatment session.

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