Why a kidney biopsy may be unnecessary

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Experts are examining when it is appropriate for the kidneys, shown in red, to undergo a biopsy.

BY AMBER SMITH

For decades, kidney experts believed that biopsies of the organ were not helpful in determining how to treat a small kidney tumor. Today, more doctors believe a biopsy helps guide treatment.

It can – sometimes, says Gennady Bratslavsky, MD, chair of Upstate’s department of urology.

Gennady Bratslavsky, MD

Gennady Bratslavsky, MD

A biopsy may be appropriate for some patients with solid kidney tumors that have not spread beyond the organ. But he says the procedure, in which tissue is removed for laboratory analysis, should not be used routinely for everyone diagnosed with a renal mass.

Bratslavsky and co-authors from the Fox Chase Cancer Center in Philadelphia and the Mayo Clinic in Rochester, Minn., argue for selective use of kidney biopsy, writing in the journal European Urology that “most patients can avoid the unnecessary procedure and its associated risks.”

Their article says a biopsy probably would not make sense for a patient with a small mass in the kidney, who is frail or has other serious medical conditions, since results are not likely to influence the patient’s treatment.

The authors give three reasons people with small kidney tumors should not automatically undergo a biopsy:

  1. Growing evidence suggests that such patients can be safely monitored through active surveillance without the tumor spreading.
  1. Kidney biopsies do a poor job of predicting how likely a tumor is to grow and spread. While learning what kind of cells make up a tumor may provide comfort — or concern — for a patient, “our experience suggests that if a renal mass in a frail, elderly or infirm patient is best managed with active surveillance, knowledge of the pathology is often irrelevant and rarely helpful for initial management,” the authors write.
  1. Many patients with kidney tumors take prescription medication that helps reduce blood clots. That increases their risk of dangerous bleeding during a biopsy.

3 patients who may require a biopsy

  • patients whose tumors have grown while they are being monitored through active surveillance.
  • frail or elderly patients with large (greater than 3 centimeters) or rapidly growing tumors.
  • patients who are extremely anxious about the tumor.

cancercaresummerThis article appears in the summer 2016 issue of Cancer Care magazine.

 

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