EUS-guided FNA aspiration of kidney masses: a multicenter U.S. experience.

Abstract

BACKGROUND:

Tissue sampling of renal lesions is traditionally performed with percutaneous US or CT guidance. To date, only 3 known cases of EUS-guided FNA (EUS-FNA) of a renal mass have been reported.

OBJECTIVE:

To describe a multicenter experience with the indications, yield, and complications from attempted EUS-FNA of a kidney mass.

DESIGN:

Retrospective case series.

SETTING:

Six tertiary referral hospitals in the United States.

PATIENTS:

Consecutive subjects undergoing attempted EUS-FNA of a kidney mass. Endosonographers at 15 other teaching hospitals were contacted regarding EUS findings and follow-up of any EUS-guided renal biopsies previously attempted or considered at that institution.

INTERVENTIONS:

EUS-FNA of a kidney mass.

MAIN OUTCOME MEASUREMENTS:

Biopsy indications, yield, diagnosis, and complications.

RESULTS:

Fifteen procedures in 15 patients (9 men; median age 67 years) were performed at 6 (37%) of 16 hospitals (Indiana University plus 15 other hospitals). Kidney masses (median diameter 32 mm; range 11-60 mm) were located in the upper (n = 12) and lower (n = 3) poles of the left (n = 10) and right (n = 5) kidneys, respectively. Initial mass detection was by previous imaging in 13 (87%) patients or by EUS in 2 (13%) patients. Results of EUS-FNA (median 3 passes; range 2-4 passes) in 13 (87%) procedures were diagnostic of (n = 7) or highly suspicious for (n = 1) renal cell carcinoma (RCC), atypical cells (n = 2), oncocytoma (n = 1), benign cyst (n = 1), and nondiagnostic (n = 1). No complications were encountered. Surgical resection confirmed RCC in 7 patients in whom preoperative EUS-FNA demonstrated RCC (n = 5) or oncocytoma (n = 1) or was not performed (n = 1).

LIMITATIONS:

Retrospective series, small number of patients.

CONCLUSIONS:

EUS-FNA of renal masses is rarely performed at the U.S. teaching hospitals surveyed. This technique appears safe and feasible and should be considered when results would affect patient management.

• Authors: John DeWitt, Frank G Gress, Michael J Levy, Lyndon V Hernandez, Mohamad A Eloubeidi, Girish Mishra, Stuart Sherman, Mohammad A Al-Haddad, Julia K LeBlanc
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 70 Issue 3 Pg. 573-8 (Sep 2009) ISSN: 1097-6779 [Electronic] United States
• PMID: 19560139 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adenoma, Oxyphilic (diagnostic imaging, pathology)
• Aged
• Aged, 80 and over
• Biopsy, Fine-Needle (adverse effects, methods)
• Carcinoma, Renal Cell (diagnostic imaging, pathology)
• Cohort Studies
• Confidence Intervals
• Endosonography (adverse effects, methods)
• Female
• Follow-Up Studies
• Hospitals, Teaching
• Humans
• Immunohistochemistry
• Kidney Neoplasms (diagnostic imaging, pathology, surgery)
• Male
• Middle Aged
• Neoplasm Staging
• Probability
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• United States