DIAGNOSIS OF RENAL-CELL CARCINOMA - VALUE OF FINE-NEEDLE ASPIRATION CYTOLOGY IN PATIENTS WITH METASTASES OR CONTRAINDICATIONS TO NEPHRECTOMY

OBJECTIVE. A retrospective study of imaging-directed percutaneous fine -needle aspiration cytology of focal renal lesions was performed. The objectives were to determine the efficacy and safety of renal aspirati on biopsy in establishing the diagnosis of renal cell carcinoma and av oiding nephrectomy in patients with a renal mass and disseminated meta stases or with a renal mass and relative contraindications to nephrect omy. MATERIALS AND METHODS. Between September 1987 and September 1991, 55 consecutive patients had 57 imaging-directed renal aspiration biop sies at our institution. We examined the medical records, pathology re ports, imaging studies, and follow-up information of the 23 patients w ho had the procedure because of disseminated metastases (10 patients) or relative contraindications to nephrectomy (13 patients). Preliminar y diagnoses were based on the cytopathology, and final diagnoses were based on the surgical pathology (six patients) or clinical course over more than 6 months (17 patients). RESULTS. Cytopathologic findings we re true-positive in 12 patients, true-negative in eight, false-negativ e in three, and false-positive in none. The sensitivity was 80%, the s pecificity was 100%, and the accuracy was 87%. Of the 10 patients with a renal mass and disseminated metastases, aspiration cytology failed to show malignancy in only one. None of these patients had surgery, an d all died within 1 year. Of the 13 patients with relative contraindic ations to surgery, seven were treated without surgery. The cytologic d iagnosis was renal cell carcinoma in two of the seven, and these two p atients have since died. Cytopathology was negative for renal cell car cinoma in five of the seven, and subsequent imaging studies in these p atients have shown no renal mass enlargement or metastases 2-3 years a fter biopsy (three patients) or the patients have died of severe heart disease (two patients). Nephrectomy was performed in the remaining si x patients, and no evidence of disease had been found 2-4 years after removal of two oncocytomas and four renal cell carcinomas. There were no significant complications. CONCLUSION. Percutaneous renal aspiratio n biopsy cytology is accurate, safe, and useful in establishing the di agnosis of renal cell carcinoma in patients with disseminated metastas es or relative contraindications to surgery.