What is the role of biopsy in the preoperative workup for partial nephrectomy nephron-sparing surgery (NSS)?

Updated: Apr 01, 2019
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

A dilemma exists with respect to the nature of the solid lesion prior to planned surgery. In a recent prospective study, 103 patients diagnosed with a solid renal mass on CT scan and scheduled for surgery were evaluated. [2]  Note the following:

  • At the time of surgery, a biopsy sample of the surgical specimen was obtained under direct vision. Frozen section biopsy samples were compared to whole tissue specimens and reviewed by 2 pathologists.

  • These experienced pathologists were able to diagnose only 3 out of 4 cases based on frozen section findings.

  • Although the positive predictive value was excellent (94%), a large degree of inaccuracy existed for benign lesions, and many biopsy samples (approximately 22%) were nondiagnostic.

  • The authors do not recommend routine use of intraoperative frozen section needle biopsy to guide surgical decision making. Percutaneous image-guided biopsies still have a role, especially to help rule out metastatic lesions. The information presented is clear evidence that, even under ideal biopsy circumstances, needle biopsy is insufficiently accurate (75%) in defining the nature of small renal lesions. For this reason, NSS with complete excision plays an important role for the small incidentally detected tumor because biopsy findings frequently do not change the surgical management.


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