Avoiding “Needless” nephrectomy: What is the role of small renal mass biopsy in 2024?

• Published in: Urologic oncology 2024-08, Vol.42 (8), p.236-244
• Main Authors: Gao, Bruce, Gorgen, Antonio R.H., Bhatt, Rohit, Tano, Zachary E., Morgan, Kalon L., Vo, Kelvin, Zarandi, Sina Soltanzadeh, Ali, Sohrab N., Jiang, Pengbo, Patel, Roshan M., Clayman, Ralph V., Landman, Jaime
• Format: Article
• Language: English
• Subjects: Biopsy; Kidney neoplasms; Nephrectomy; Small renal mass
• ISSN: 1078-1439; 1873-2496; 1873-2496
• DOI: 10.1016/j.urolonc.2024.04.002

•Preoperative biopsy is standard of care for other solid organ systems.•Renal mass biopsy (RMB) accuracy and safety matches other solid organ biopsies.•RMB should be performed in any patient with a SRM seeking treatment.•RMB for small renal masses (SRM) reduces surgeries for benign renal masses. Current guidelines do not mandate routine preoperative renal mass biopsy (RMB) for small renal masses (SRMs), which results in a considerable rate (18%–26%) of needless nephrectomy/partial nephrectomy for benign renal tumors. In light of this ongoing practice, a narrative review was conducted to examine the role of routine RMB for SRM. First, arguments justifying the current non-biopsy approach to SRM are critically reviewed and contested. Second, as a standalone procedure, RMB is critically assessed; RMB was found to have higher sensitivity, specificity, and an equal or lower complication rate when compared with other commonly preoperatively biopsied solid organ tumors (e.g., breast, prostate, lung, pancreas, thyroid, and liver). Based on the foregoing information, we propose a paradigm shift in SRM management, advocating for an updated policy in which partial nephrectomy or nephrectomy for SRM invariably occurs only after a preoperative biopsy confirms that a SRM is indeed malignant.