SAN FRANCISCO—Percutaneous image-guided renal mass biopsy (RMB) combined with immunohistochemical (IHC) results can accurately distinguish between benign and malignant tumors, a finding that could help prevent unnecessary nephrectomies, researchers reported at the 37th Annual Scientific Meeting of the Society of Interventional Radiology.

“Traditionally, solid renal masses were not biopsied because if the lesion could not be characterized as benign on imaging, it was presumed to be cancer and was removed surgically,” said study investigator Nisha Alle, BS, who is with the Department of Radiology at David Geffen School of Medicine, University of California-Los Angeles. “But we are finding that a significant subset of these small renal masses is in fact benign on nephrectomy, so it would be helpful to have a pre-procedural biopsy diagnosis of a solid renal mass to avoid any unnecessary surgery or ablation.”

Alle and her colleagues retrospectively studied 173 consecutive patients who underwent percutaneous computed tomography (CT) or ultrasound-guided RMB from March 2002 through January 2012. Biopsies of renal parenchyma for diagnosis of medical renal diseases were excluded. The investigators evaluated imaging variables (including size, location, and extent of disease), number of core biopsies, patient demographics (age, gender), clinical indication, final pathologic diagnosis, IHC studies, and subsequent final pathological diagnosis on nephrectomy. 

Fourteen of the 173 patients (8.1%) were excluded because biopsies were performed at an outside institution, medical records were incomplete, or lesions were poorly visualized. Three patients had two renal mass biopsies for bilateral renal cell carcinoma (RCC). Of 159 patients with 162 RMB, 114 (71.7%) were male, with a mean age of 69. Of 162 RMB, 111 were malignant (68.5%), 39 were benign (24.1%), and 12 were non-diagnostic (7.4%).

IHC was performed for 110 biopsies (67.9%) and was diagnostic in 93% of those cases; 22 patients underwent subsequent partial nephrectomy. In all cases, RMB was concordant with nephrectomy pathology findings for malignancy. In 76% of cases, RMB was concordant for subtype of RCC. However, in two cases, RMB diagnosis of clear cell RCC was changed to papillary type 2 on nephrectomy. For one patient, RMB diagnosis of papillary type 1 RCC was changed to unclassified RCC, and for another, a biopsy diagnosis of unclassified RCC was changed to clear cell RCC. In another case, an initial diagnosis of unclassified RCC on biopsy was changed to chromophobe. In one case of a non-diagnostic biopsy, the final pathologic diagnosis was solitary fibrous tumor on nephrectomy.

Overall, the combination of RMB and IHC had a sensitivity, specificity, and positive predictive value for detecting malignancy of 100%.

“Routine H&E staining may not able to sufficiently differentiate among different tumor subtypes, but adding immunohistochemical studies for most tumors confers high accuracy for diagnosis,” Alle said. “We only had 12 complications over a time period of 10 years and there were no long-term complications.”

She also noted that no cases of tumor seeding attributed to biopsy were identified.

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Patients with papillary renal cell carcinoma, the second most common kidney cancer subtype, face a low risk of tumour recurrence and cancer-related death after surgery. Those are the key findings of a multi-centre study of nearly 600 patients published in the April issue of the urology journal BJUI.   

"Because papillary renal cell carcinoma (pRCC) only affects ten to 15% of kidney cancer patients, the small number of patients enrolled in individual studies makes it hard to draw meaningful conclusions about how the disease will progress" says lead author Dr Vincenzo Ficarra, associate professor of urology at the University of Padua, Italy.

"Bringing together data on 577 patients from 16 academic centres across Italy has enabled us to study this subtype in more detail than a single-centre study would allow."

The patients with pRCC were identified from 5,463 patients with suspected renal cell carcinoma at the centres between 1995 and 2007. Follow-up ranged from 22 to 72 months and the median was just over 39 months.

Key findings of the study, which forms part of a larger research project promoted by LUNA, the clinical research office of the Italian Society of Urology, include:

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MONEY MAKER: Dialysis Unit nets $1.4M for BVIHSA

Dialysis involves elimination of waste matter from the blood and maintaining electrolyte balance through osmosis. Dialysis does not treat renal failure but keeps the patient alive by artificially performing the function of cleaning the blood.

There are 41 patients in the BVI  who utilize the dialysis machines at Peebles Hospital – and the cost per month for an “average patient” costs almost $17,000 per month.

Acting Chief Executive Officer of the BVI Health Services Authority (BVIHSA), Dr. Ronald Georges, told the Standing Finance Committee that of the 41 clients on dialysis 16 are covered by insurance, 12 are exempted from paying under the regulations because of their age, and 15 are unable to pay.

Representative for the Third District, Julian Fraser, inquired  where the BVIHSA gets its income for dialysis in the amount of $1.4 million, and asked whether the revenue came from insurance. Dr. Georges replied by saying that the revenue for dialysis is collected from insurance agencies. He noted that 16 of the patients who receive dialysis are insured.

Fraser asked the official to give an insight into the cost of dialysis for a patient to which Dr. Georges said $12,000 per session and $16,500 per month for the average dialysis patient.

When asked by the Third District representative about the percentage covered by insurance agencies, Dr. Georges said one of the insurance providers, BUPA, reimburses 100 percent and the other agencies 50 percent; another 50 percent goes unpaid.

Fraser also asked the acting chief executive officer whether the cost of $16,500 per month for dialysis was a real cost incurred or factors in other profits, and whether it was a cost to government.

Dr. Georges said the cost for providing the service includes the human resource, overhead utilities, space, and all of the supplies and maintenance of the equipment that is required. Fraser asked Dr. Georges if anyone has ever been turned away because  the authority may not have the capacity to treat that patient.

Dr. Georges replied by saying that the Authority was presently at the breaking point, particularly in the Dialysis Unit, in terms of the quantity of patients and the current capacity of the unit. He also stated that the Authority was thinking of doing some minor expansions to that unit to have an additional three stations as the equipment was donated by the University of Michigan and the Rotary Club.

He further stated that there would be some minor modifications to the unit and staffing changes to accommodate a larger number of clients who require dialysis.

Copyright 2012 BVI News, Alliance News Limited. All Rights Reserved. This material may not be published, broadcast, rewritten or distributed.

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Dialysis Unit nets $1.4M in revenues for BVIHSA

Dialysis involves elimination of waste matter from the blood and maintaining electrolyte balance through osmosis. Dialysis does not treat renal failure but keeps the patient alive by artificially performing the function of cleaning the blood.

There are 41 patients in the BVI  who utilize the dialysis machines at Peebles Hospital – and the cost per month for an “average patient” costs almost $17,000 per month.

Acting Chief Executive Officer of the BVI Health Services Authority (BVIHSA), Dr. Ronald Georges, told the Standing Finance Committee that of the 41 clients on dialysis 16 are covered by insurance, 12 are exempted from paying under the regulations because of their age, and 15 are unable to pay.

Representative for the Third District, Julian Fraser, inquired  where the BVIHSA gets its income for dialysis in the amount of $1.4 million, and asked whether the revenue came from insurance. Dr. Georges replied by saying that the revenue for dialysis is collected from insurance agencies. He noted that 16 of the patients who receive dialysis are insured.

Fraser asked the official to give an insight into the cost of dialysis for a patient to which Dr. Georges said $12,000 per session and $16,500 per month for the average dialysis patient.

When asked by the Third District representative about the percentage covered by insurance agencies, Dr. Georges said one of the insurance providers, BUPA, reimburses 100 percent and the other agencies 50 percent; another 50 percent goes unpaid.

Fraser also asked the acting chief executive officer whether the cost of $16,500 per month for dialysis was a real cost incurred or factors in other profits, and whether it was a cost to government.

Dr. Georges said the cost for providing the service includes the human resource, overhead utilities, space, and all of the supplies and maintenance of the equipment that is required. Fraser asked Dr. Georges if anyone has ever been turned away because  the authority may not have the capacity to treat that patient.

Dr. Georges replied by saying that the Authority was presently at the breaking point, particularly in the Dialysis Unit, in terms of the quantity of patients and the current capacity of the unit. He also stated that the Authority was thinking of doing some minor expansions to that unit to have an additional three stations as the equipment was donated by the University of Michigan and the Rotary Club.

He further stated that there would be some minor modifications to the unit and staffing changes to accommodate a larger number of clients who require dialysis.

Copyright 2012 BVI News, Alliance News Limited. All Rights Reserved. This material may not be published, broadcast, rewritten or distributed.

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