When is a tissue diagnoses indicated prior to radical nephrectomy?

Updated: Feb 05, 2019
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Link et al reviewed the results of 223 laparoscopic partial nephrectomies and found that only 66.4% of patients had renal cell cancer in the final pathology (mean tumor size, 2.6 cm). [9] Some centers advocate intraoperative needle biopsy of these solid renal masses with immediate frozen-tissue sectioning to help identify patients who may benefit from NSS or radical nephrectomy if specific tumor histology can be determined.

A urologist should seek a tissue diagnosis only if an indeterminate or solid lesion is found in a patient with known nonrenal cancer (ie, differential diagnosis of primary renal cancer vs a metastatic lesion). In rare cases, tumors have an infiltrating pattern on CT scans and are suspicious for lymphoma. In this regard, an ultrasound-guided or CT-guided puncture or biopsy of the lesion is indicated.


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