Segurança e Acuidade Diagnóstica da Biópsia Percutânea de Massas Renais: Uma Experiência Inicial de um Único Centro
DOI:
https://doi.org/10.24915/aup.35.1-2.48Palavras-chave:
Biópsia por Agulha, Nefrectomia, Neoplasias do RimResumo
Introdução: A caracterização de massas renais através da realização de biópsia antes do tratamento cirúrgico é atualmente uma opção. Sem esta caracterização prévia doentes com massas renais benignas podem ser submetidos a cirurgias desnecessárias. O objetivo foi determinar a acuidade diagnóstica e a segurança da biópsia de massas renais.
Material e Métodos: Estudo prospetivo uni-institucional de 38 doentes submetidos a biópsia de massa renal no período compreendido entre julho de 2014 e maio de 2016.
Resultados: A biópsia foi diagnóstica em 76,3% (n = 29) dos casos. Em 21,7% (n = 6) das biópsias diagnósticas, a análise histológica demonstrou lesões benignas. Nos doentes submetidos a cirurgia verificou-se uma concordância global de 100% entre o resultado da biópsia e o resultado patológico da peça cirúrgica. A taxa de complicações foi de 5,3% (n = 2), ambas classificadas como grau I na escala Clavien-Dindo.
Conclusão: A biópsia de massas renais mostrou elevada acuidade diagnóstica e segurança, podendo evitar a realização de cirurgias desnecessárias. Este procedimento poderá vir a fazer parte da avaliação prévia à decisão de tratamento em doentes com massas renais.
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2. Wein AJ, Kavoussi LR, Partin AW, Peters C, Campbell MF, Walsh PC. Campbell- Walsh urology. 11th ed. Philadelphia: Elsevier; 2016.
3. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015; 67:913-24.
4. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004; 100:738-45.
5. Vasudevan A, Davies RJ, Shannon BA, Cohen RJ. Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy. BJU Int. 2006; 97:946-9.
6. Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol. 2008; 179:1227-33; discussion 33-4.
7. Remzi M, Marberger M. Renal tumor biopsies for evaluation of small renal tumors: why, in whom, and how? Eur Urol. 2009; 55:359-67.
8. Remzi M, Katzenbeisser D, Waldert M, Klingler HC, Susani M, Memarsadeghi M, et al. Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign
tumours are not necessarily small. BJU Int. 2007; 99:1002-6.
9. Zhang L, Li XS, Zhou LQ. Renal Tumor Biopsy Technique. Chin Med J. 2016; 129:1236-40.
10. Lane BR, Samplaski MK, Herts BR, Zhou M, Novick AC, Campbell SC. Renal mass biopsy--a renaissance? J Urol. 2008; 179:20-7.
11. Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016; 69:660-73.
12. Volpe A, Kachura JR, Geddie WR, Evans AJ, Gharajeh A, Saravanan A, et al. Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol. 2007; 178:379-86.
13. Wang R, Wolf JS, Wood DP , Higgins EJ, Hafez KS. Accuracy of percutaneous core biopsy in management of small renal masses. Urology. 2009; 73:586-90; discussion 90-1.
14. Barwari K, de la Rosette JJ, Laguna MP. The penetration of renal mass biopsy in daily practice: a survey among urologists. J Endourol. 2012; 26:737-47.
15. Caoili EM, Bude RO, Higgins EJ, Hoff DL, Nghiem HV. Evaluation of sonographically guided percutaneous core biopsy of renal masses. AJR Am J Roentgenol. 2002; 179:373-8.
16. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178:41-6.
17. Lesage K, Joniau S, Fransis K, Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol. 2007; 51:614-20.
18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187-96.
19. Leveridge MJ, Finelli A, Kachura JR, Evans A, Chung H, Shiff DA, et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol. 2011; 60:578-84.
20. Richard PO, Jewett MA, Bhatt JR, Kachura JR, Evans AJ, Zlotta AR, et al. Renal Tumor Biopsy for Small Renal Masses: A Single-center 13-year Experience. Eur Urol. 2015; 68:1007-13.
21. Volpe A, Finelli A, Gill IS, Jewett MA, Martignoni G, Polascik TJ, et al. Rationale for percutaneous biopsy and histologic characterisation of renal tumours. Eur Urol. 2012; 62:491-504.
22. Millet I, Curros F, Serre I, Taourel P, Thuret R. Can renal biopsy accurately predict histological subtype and Fuhrman grade of renal cell carcinoma? J Urol. 2012; 188:1690-4.
23. Campbell SC, Novick AC, Herts B, Fischler DF, Meyer J, Levin HS, et al. Prospective evaluation of fine needle aspiration of small, solid renal masses: accuracy and morbidity. Urology. 1997; 50:25-9.
24. Barocas DA, Rohan SM, Kao J, Gurevich RD, Del Pizzo JJ, Vaughan ED, Jr., et al. Diagnosis of renal tumors on needle biopsy specimens by histological and molecular analysis. J Urol. 2006; 176:1957-62.
25. Barocas DA, Mathew S, DelPizzo JJ, Vaughan ED, Jr., Sosa RE, Fine RG, et al. Renal cell carcinoma sub-typing by histopathology and fluorescence in situ hybridization on a needle-biopsy specimen. BJU Int. 2007; 99:290-5.
26. Takahashi M, Rhodes DR, Furge KA, Kanayama H, Kagawa S, Haab BB, et al. Gene expression profiling of clear cell renal cell carcinoma: gene identification and prognostic classification. Proc Natl Acad Sci U S A. 2001; 98:9754-9.
27. Lane BR, Li J, Zhou M, Babineau D, Faber P, Novick AC, et al. Differential expression in clear cell renal cell carcinoma identified by gene expression profiling. J Urol. 2009; 181:849-60.
Publicado
2018-07-24
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