Early-stage renal-cell carcinoma is more frequently diagnosed due to more f
requent use of advanced radiologic techniques. Partial nephrectomy may be c
urative for small tumors and may sometimes be necessary if the opposite kid
ney is functionally compromised. This therapeutic option is however not pos
sible in high-grade neoplasms. In the current study, we attempted to grade
cases of renal-cell carcinoma on smears obtained from preoperative fine-nee
dle aspirates (FNA). Eighteen cases of histologically proven renal-cell car
cinoma formed the basis of this study FNAs were performed prior to nephrect
omy. FNA smears were blindly reviewed, and the cases were evaluated for cel
lularity nuclear to cytoplasmic (N/C) ratios, nuclear pleomorphism, and the
presence of naked nuclei and prominent nucleoli; cases were graded accordi
ng to the presence or absence of these criteria and their combination. The
cases were cytologically graded from grade I-IV and then were given a low g
rade if the tumor was considered grade I or II, or high grade if the tumor
was considered grade III or IV: The histology of the neoplasms was reviewed
, and the tumors were graded according to the Fuhrman nuclear grading syste
m. Correlation between the cytologic and histologic grades within the same
histologic grade was seen in 13 of the 18 cases (72.2%). The difference was
no more than one grade for each discrepancy. When grading as high or low g
rade was used, agreement was seen in 100% of the cases. The most reliable c
ytologic features seen on cytology distinguishing low-from high-grade tumor
s were the N/C ratio and the presence or absence of nucleoli. Pleomorphism,
naked nuclei, and increased cellularity were less distinguishing features.
We conclude that grading of renal-cell carcinoma can be reliably achieved
in FNA material. Preoperative FNAs can thus be performed on small renal neo
plasms with subsequent conservative treatment if the tumor proves to be low
grade. (C) 2000 Wiley-Liss,Inc.