Limitations of preoperative biopsy in patients with metastatic renal cell carcinoma: comparison to surgical pathology in 405 cases

作者：Abel E Jason; Carrasco Alonso; Culp Stephen H; Matin Surena F; Tamboli Pheroze; Tannir Nizar M; Wood Christopher G^*

来源：BJU International, 2012, 110(11): 1742-1746.

DOI：10.1111/j.1464-410X.2012.11124.x

• renal cell carcinoma
• metastatic
• biopsy
• targeted therapy
• pre-surgical therapy
• sarcomatoid

OBJECTIVE %26lt;br%26gt;To evaluate the ability of preoperative biopsy to identify high-risk pathological features by comparing pathology from preoperative metastatic site and primary tumour biopsies with nephrectomy pathology in patients with metastatic renal cell carcinoma (mRCC). %26lt;br%26gt;PATIENTS AND METHODS %26lt;br%26gt;We reviewed clinical and pathological data from patients who underwent biopsy before cytoreductive nephrectomy for mRCC at MD Anderson Cancer Center (MDACC) from 1991 to 2007. %26lt;br%26gt;Percutaneous biopsy techniques included fine-needle aspiration, core needle biopsy or a combination of both techniques. %26lt;br%26gt;RESULTS %26lt;br%26gt;The pathology of 405 preoperative biopsies (239 metastatic site, 166 primary tumour) from 378 patients was reviewed at MDACC before cytoreductive nephrectomy. %26lt;br%26gt;The biopsy and nephrectomy specimens had the same histological subtype in 96.0% of clear-cell renal cell carcinomas (RCCs) and 72.7% of non-clear-cell RCCs. %26lt;br%26gt;Of 76 nephrectomy specimens where sarcomatoid de-differentiation was identified, only seven (9.2%) were able to be identified from the preoperative biopsy. %26lt;br%26gt;In 38.3% of patients, the same Fuhrman grade was identified in both the biopsy and nephrectomy specimens. %26lt;br%26gt;A definitive diagnosis of RCC was more likely to be reported in primary tumour biopsies than in metastatic site biopsies. (P %26lt; 0.001). %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;Preoperative biopsy has limited ability to identify non-clear-cell histological subtype, Fuhrman grade or sarcomatoid features. %26lt;br%26gt;When surgical pathology is not available, a biopsy obtaining multiple samples from different sites within the primary tumour should be recommended rather than limited metastatic site biopsy to identify patients for clinical trials.

• 出版日期2012-12