《Heterogeneity and renal mass biopsy：a review of its role and reliability》.pdfVIP

Cancer Biol Med 2014;11;162-172. doi: 10.7497/j.issn.2095-3941.2014.03.002 REVIEW Heterogeneity and renal mass biopsy: a review of its role and reliability 1 2 2 Jeffrey J. Tomaszewski , Robert G. Uzzo , Marc C. Smaldone 1Division of Urology, Department of Surgery, MD Anderson Cancer Center at Cooper, Rowan University School of Medicine, Camden, NJ, 08103, USA; 2 Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, 19111, USA AbstrAct Increased abdominal imaging has led to an increase in the detection of the incidental small renal mass (SRM). With increasing recognition that the malignant potential of SRMs is heterogeneous, ranging from benign (15%-20%) to aggressive (20%), enthusiasm for more conservative management strategies in the elderly and infirmed, such as active surveillance (AS), have grown considerably. As the management of the SRM evolves to incorporate ablative techniques and AS for low risk disease, the role of renal mass biopsy (RMB) to help guide individualized therapy is evolving. Historically, the role of RMB was limited to the evaluation of suspected metastatic disease, renal abscess, or lymphoma. However, in the contemporary era, the role of biopsy has grown, most notably to identify patients who harbor benign lesions and for whom treatment, particularly the elderly or frail, may be avoided. When performing a RMB to guide initial clinical decision making for small, localized tumors, the most relevant questions are often relegated to proof of malignancy and documentation (if possib