Fine needle aspiration (FNA) with and without concurrent core needle biopsy (CNB) is a minimally invasive method to diagnose and assist in management of renal masses. We aimed to assess the pathologic accuracy of FNA compared to and associated with CNB, and impact on management.
This is a single institution retrospective study of 342 cases from 2001 to 2015 with small and large renal masses (≤4 and >4 cm). Diagnostic and concordance rates and impact on management were analyzed.
Adequacy rates for FNA only, CNB only, and FNA+CNB were 21%, 12%, and 8% (FNA vs FNA+CNB, p<0.026). In the FNA+CNB group, adding FNA to CNB and CNB to FNA reduced the inadequacy rate from 23% to 8%, and from 27% to 8%, for total reduction rate of 15% and 19%, corresponding to 32 cases (9.3%). Rapid on-site examination contributed to a 22.5% improvement in adequacy rates for FNA. Thirty percent of FNA only, 5% of CNB only and 12% of FNA+CNB could not be subtyped (FNA vs CNB, P <0.0001; FNA vs FNA+CNB, P<0.0127; CNB vs FNA+CNB, P=0.06). Diagnostic concordance rate with surgical resection was 99%. Conversion of an inadequate specimen to adequate by a concurrent procedure impacted management in at least 29 of 32 patients. Limitations include retrospective design and accuracy measurement based on surgical intervention.
FNA+CNB versus at least FNA alone may improve diagnostic yield when sampling renal masses but has similar subtyping potential to CNB only.
The Journal of urology. 2017 Jan 13 [Epub ahead of print]
F Cate, M Kapp, S A Arnold, L L Gellert, O Hameed, P E Clark, G Wile, A Coogan, G A Giannico
Department of Pathology, Microbiology and Immunology, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232., Department of Pathology, Microbiology and Immunology, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232; Department of Veterans Affairs, 1310 24th Avenue South, Nashville, TN 37212., Department of Pathology, Microbiology and Immunology, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232; Department of Urologic Surgery, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232., Department of Urologic Surgery, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232., Department of Radiology, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232., Department of Pathology, Microbiology and Immunology, 1161 21(st) Ave. S. Vanderbilt University Medical Center, Nashville, TN 37232. Electronic address: .