Page 7 - Role of renal mass biopsy in the management of kidney cancer: KCRNC

Consensus: Renal mass biopsy

Summary of consensus statements
1. Renal mass biopsy should be offered to patients with a renal mass when the result of the biopsy will alter their management.
2. Renal mass biopsy should include at least 2-3 core biopsies to sample the mass. Fine needle aspiration is not sufficient.

3. The diagnostic accuracy of renal mass biopsy varies by hospital, mass size, mass location, and patient factors.
4. Renal mass biopsy is safe with low rates of complications when performed at experienced centres in properly selected patients.
Patients should be informed of the risk of complications.
5. Renal mass biopsy should routinely be discussed with patients with a small renal mass prior to management.

6. Shared decision-making should be used to determine if renal mass biopsy will be performed. Patients should be informed of the
possible benefits and harms, what is known about the diagnostic accuracy of the biopsy, and how the biopsy should be interpreted.
Patients’ values and preferences should be elicited. Most importantly, it should be determined whether the results of the biopsy will
influence management.

7. Patients who have a non-diagnostic renal mass biopsy for a small renal mass, should be counseled on the benefits and harms of a
repeat biopsy.
8. Patients who have a renal mass biopsy with benign histology, should be informed about the risk of a false negative biopsy and should
be monitored.
9. Renal mass biopsy should not be recommended to patients in whom active surveillance or watchful waiting will be recommended
irrespective of the biopsy result because of competing risks.
10. Renal mass biopsy should not be recommended to patients who will want to proceed with definitive management irrespective of the
biopsy result.

11. Renal mass biopsy should not be performed in patients with a renal mass showing classic radiologic appearance of an
angiomyolipoma.
12. Biopsy of cystic renal masses may be considered if there is a significant solid component amenable to biopsy. Renal masses without a
solid component should not be biopsied due to low diagnostic yield.
13. Renal mass biopsy should be performed when a pathology other than renal cell carcinoma is suspected for a mass that may require
management (e.g., lymphoma, metastatic lesion).
14. Renal mass biopsy or biopsy of metastatic lesion should be considered to obtain a diagnosis in patients with suspected metastatic
renal cell carcinoma.

15. Renal mass biopsy should be performed prior to, or at the time of, thermal ablation or radiotherapy of the mass.

CUAJ • December 2019 • Volume 13, Issue 12 383