Renal cancer biopsy: When and How?

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Renal cancer is a silent cancer though but due to an increasing utility of ultrasonography and CT scan in routine over the medical checkup’s result in incidentally detected a small renal mass or (SRMs). The definition of SRMs is a solid kidney lesion which is less than 4 cm. These SRMs has 80% chance to be a cancer and 20% to be a benign lesion. Traditionally, urologists always encouraging everyone who had SRMs undergoing the operation which will sometimes surprise both surgeon and patients when the pathological result come out just benign. That’s why renal mass biopsy was suggested and increased usage overtime.

Renal cancer biopsy was invented due to the concern of the over-treatment in benign and low-grade tumor. Moreover, the biopsy can even guide us what kind of the treatment modality is the most suitable among individuals. In term of the procedure or technique, renal mass biopsy can be done as out-patient basis. The biopsy will be done by placing patient with prone position, then infused pain killer at the flank area where the targeted kidney is.

Technical concerns on Renal cancer biopsy

1. Obesity – Skin to mass length
2. Position of the renal mass – Posterior side is easily access than anterior side renal mass
3. Number of biopsy shots – 2 to 3 cores is recommended
4. Accuracy rate – Up to 92% was reported

Patient safety on Renal cancer biopsy

1. Less than 2% of complications were reported for example – perinephric hematoma, flank pain, bloody urination and pneumothorax
2. Massive bleeding is rare and usually self-limited
3. Tumor seeding along the biopsy tract is nearly negligible due to the modern biopsy technique.

Once we get the pathology, then we can consider the plan as following

1. Renal cancer – The operation choice will be assess tailored-made.
2. Benign mass – Recommended as a regular imaging surveillance and will re-consider biopsy with the following circumstances
   • Tumor is keep growing more than 4 cm in maximum diameter
   • Rate of tumor growing more than 5 mm per year

Small renal mass issue is a sensitive problem which need sharing the decision making and good relationship between urologist and the patients. Because sometimes it makes patients upset and worry when there is possibly renal cancer in their body without any plan of t removing method. Our principle is telling them the truth which based on the scientific evidence guideline. Any questions, you can discuss with your trusted urologist, or it would be my honor if you can text me. Please take care!

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