Grade Heterogeneity in Small Renal Masses: Potential Implications for Renal Mass Biopsy

• DOI: 10.1016/j.juro.2014.06.067
• Publication Date: 2014-06-21T16:15:45Z
• Authors: Mark W. Ball; Stephania M. Bezerra; Michael A. Gorin; Morgan Cowan; Christian P. Pavl...; Phillip M. Pieror...; George J. Netto; Mohamad E. Allaf
• Keywords: Renal mass

Understanding the degree of phenotypic heterogeneity in a small renal mass may have implications for interpreting biopsy data. In this study we quantify nuclear grade masses.Our institutional database was queried patients with T1a (less than 4 cm) masses stratified by criteria imaging diameter less 2 cm or greater, clear cell papillary histology, low (Fuhrman 1-2) high 3-4) tissue available review. Four consecutive specimens were chosen from each 8 strata total 32. All reanalyzed and highest Fuhrman present 10× powered field recorded. A case classified as heterogeneous if multiple grades discordant 50% specimen.A median 5 slides (IQR 3.5-7.5) 59, fields 34-109) examined per patient. Overall 26 samples (81.3%) heterogeneous, including 15 16 (93.8%) specimens. Among all cases 10 (31.3%) (25%) discordant. Median fraction 38.9% 12.2-57.2).The majority demonstrated considerable heterogeneity. The greatest discordance observed tumors. One should consider these findings when data risk under sampling tumors not be insignificant.