Page 5 - Role of renal mass biopsy in the management of kidney cancer: KCRNC

Consensus: Renal mass biopsy

Other indications for renal mass biopsy If the patient was to develop metastatic disease following
treatment, the tissue obtained in the renal mass biopsy could
13. Renal mass biopsy should be performed when a pathol- be used to guide systemic treatment. Additionally, benign
ogy other than RCC is suspected for a mass that may pathology may help avoid overtreatment. When possible,
require management (e.g., lymphoma, metastatic lesion). a renal mass biopsy should be performed prior to ablation
14. Renal mass biopsy or biopsy of a metastatic lesion or radiotherapy to allow better patient counselling. In high-
should be considered to obtain a diagnosis in patients risk patients (e.g., on anticoagulation) who are unable or
with suspected metastatic RCC. unwilling to receive two procedures (biopsy and treatment),
15. Renal mass biopsy should be performed prior to, or at a biopsy should be performed at the time of the treatment.
the time of, thermal ablation or radiotherapy of the mass.
For patients with renal masses that do not have an
imaging phenotype typical of RCC or who have a past his- Summary
tory of disease that may cause a non-RCC renal mass, a
renal mass biopsy should be considered. Other processes Renal mass biopsy is an effective and safe diagnos-
can cause renal masses on imaging, including upper tract tic tool for properly selected patients. As a guiding
urothelial cell carcinoma, infection, inflammation, lymph- principle, renal mass biopsy should be reserved for
oproliferative disorders, and metastatic cancer from a dif- patients in whom the results will affect their man-
ferent primary. Eliciting a history of symptoms or a past agement choices. Shared decision-making between
medical history fitting these other causes is important in the physicians and patients should be used when con-
assessment of a patient referred with a renal mass. Patients sidering this test to investigate a renal mass.
with renal masses that may be suspicious for an upper tract
urothelial cell carcinoma should have urine cytology and
possible endoscopic evaluation, depending on the estimated
probability of a collecting system malignancy. Patients with
inflammatory or infectious causes of a renal mass may have Competing interests: Dr. Lavallée has been an advisory board member for Ferring and Sanofi;
systemic symptoms of fever, chills, rash, or imaging with sig- and received a grant from Sanofi. Dr. Kapoor has attended advisory boards for and participated in
clinical trials supported by Amgen, Astellas, Janssen, GSK, Novartis, Pfizer, and Sanofi. Dr. Pouliot
nificant perinephric stranding. Lymphoma is rarely the cause has been an advisory board member for Amgen, Astellas, and Pfizer; has been a speaker for
of a solitary renal mass, however, it is the most common Sanofi; and has received payment/grants/honoraria from Amgen, Astellas, AstraZeneca, Janssen,
41
hematological malignancy to appear in a kidney. Renal Pfizer, and Sanofi. Dr. Violette has been a speaker for Janssen and Sanofi (with no honoraria). Dr.
involvement of lymphoma can vary in appearance from Richard has been an advisory board member for BMS and Sanofi; has been a speaker for Abbvie,
multifocal, ill-defined, hypovascular lesions of different sizes Amgen, Astellas, Ferring, and Janssen; and has participated in clinical trials for Calithera and Lidds
to an infiltrative mass extending from the retroperitoneum Pharma. Dr. Karakiewicz has been an advisory board member for Pfizer; has received payment for
with or without lymphadenopathy. Finally, patients with a advisory board presentations from Abbvie, Astellas, Ferring, Janssen, and Pfizer; and has received a
42
history of a concurrent or prior non-RCC malignancy must research grant from Pfizer. Dr. Lattouf has been an advisory board member for and received honoraria
also be evaluated for the possibility of a metastatic deposit. from Abbvie, AstraZeneca, Bayer, Novartis, Pfizer, and Takeda. Dr. Kassouf has received grants/
Solitary metastatic lesions are rarely present in the kidney, honoraria from Astellas, AstraZeneca, Janssen, Merck, and Roche. Dr. Tanguay has been an advisory
but have been reported from melanoma, lung cancer, colon board member for Pfizer; and received a travel grant from Sanofi. Dr. So has been a speaker for
Amgen, Astellas, and Janssen. Dr. Rendon has been an advisory board member and speaker for,
41
cancer, and thyroid cancer. When there is a concern that and received honoraria from Abbvie, Amgen, Astellas, Astra Zeneca, Bayer, Ferring, Jansen, and
a renal mass could represent a pathology other than RCC, Sanofi. The remaining authors report no competing personal or financial interests related to this work.
a renal mass biopsy should be considered.
Renal mass biopsy should be considered in patients with
de novo metastatic disease suspected to be RCC in origin. This paper has been peer-reviewed.
A biopsy of the renal mass or a metastatic deposit are both
reasonable options to obtain a tissue diagnosis if upfront
systemic therapy is contemplated. A renal mass biopsy of
the kidney provides the most reliable pathology in many References
cases. 43,44 Confirming the diagnosis and histology of the renal
mass is important, as it may impact the options for systemic 1. Turner R, Morgan T, Jacobs BL. Epidemiology of the small renal mass and the treatment disconnect
therapy and eligibility for clinical trials. phenomenon. Urol Clin North Am 2018;44:147-54. https://doi.org/10.1016/j.ucl.2016.12.001
Finally, for patients in whom radiofrequency ablation, 2. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2018. CA Cancer J Clin 2018;67:7-30.
https://doi.org/10.3322/caac.21387
cryoablation, or radiotherapy of the renal mass is being con- 3. Kane CJ, Mallin K, Ritchey J, et al. Renal cell cancer stage migration. Cancer 2008;113:78-83.
sidered, a renal mass biopsy should be performed before https://doi.org/10.1002/cncr.23518
or at the time of the treatment, depending on the patient’s
clinical status and ability to tolerate multiple procedures. 12,14

CUAJ • December 2019 • Volume 13, Issue 12 381