Practice Pearls: Renal Cell Carcinoma
Rachel Kwon, MD
Managing Editor at MDCalc
- Controversies: Outlines of key debates in current RCC management and the evidence behind them, as well as the latest in basic science and surgical techniques.
- Guidelines: MDCalc-ified versions of standard practice guidelines at a glance, starting with NCCN and AUA recommendations for follow-up in RCC.
- Quick Tips: Basics of RCC workup for the nonspecialist, including what labs to order, when to refer, when to obtain a bone scan, and more.
Should All Renal Masses Undergo Biopsy?
- “[Renal mass biopsy] is in fact a safe and accurate diagnostic technique.” —Ordon 2013, “Renal Mass Biopsy: ‘Just Do It’”
- “Routine [biopsy] for small renal masses informs treatment decisions and diminishes unnecessary intervention. Our results support its systematic use and suggest that a change in clinical paradigm should be considered.” Richard 2015, “Renal Tumor Biopsy for Small Renal Masses: A Single-center 13-year Experience”
- “The use of biopsy to guide treatment decisions for small incidentally detected renal tumors is cost-effective and can prevent unnecessary surgery in many cases.” —Pandharipande 2010, “Renal Mass Biopsy to Guide Treatment Decisions for Small Incidental Renal Tumors: A Cost-effectiveness Analysis”
- “There are 8 established indications for percutaneous biopsy, and reason to believe that the number of indications will expand further in the future.” —Sahni 2009, “Biopsy of renal masses: when and why”
- “...the true impact of percutaneous biopsies on primary treatment algorithms remains undetermined, limiting the use of percutaneous biopsies to select patients.” —Crispen 2009, “Do Percutaneous Renal Tumor Biopsies at Initial Presentation Affect Treatment Strategies?”
- “The emerging ‘biopsy always’ strategy is currently no more justified than the historic ’biopsy never’ practice...in a large proportion of patients, renal mass biopsy in its current form does not alter clinical management, and its routine use in all-comers is not indicated outside of clinical protocols.”—Kutikov 2016, “Renal Mass Biopsy: Always, Sometimes, or Never?”