PROSPECTIVE EVALUATION OF FINE-NEEDLE ASPIRATION OF SMALL, SOLID RENAL MASSES - ACCURACY AND MORBIDITY

Objectives. To determine the accuracy and clinical utility of fine nee dle aspiration (FNA) of small, solid renal masses. Methods, A total of 25 patients with small (less than 5.0 cm), solid, clinically localize d renal masses were prospectively identified and evaluated with comput ed tomography guided FNA with analysis for presence of malignant cells and determination of nuclear grade. The final pathologic findings wer e used for comparison in each case. All patients had renal cell carcin oma and were managed with radical or partial nephrectomy; 3 had low-gr ade lesions (Fuhrman's grade 1/4), 2 had high-grade lesions (Fuhrman's grade 4/4),. and all other patients had intermediate-grade lesions (F uhrman's grade 2/4 or 3/4) on final histopathologic assessment. Result s. Overall, 10 aspirations yielded diagnostic malignant cells, and 9 w ere read as rare atypical cells suspicious for malignancy. The remaind er were negative (n = 6). Correlation with final nuclear grade was obs erved in eight instances and discordance in two instances. Subcapsular hematomas were observed at the time of surgery in 10 patients, but in no instance was the operation adversely affected. Conclusions. The di agnostic yield of FNA of small, solid renal masses appears to be too l ow to justify the potential morbidity of the procedure. (C) 1997, Else vier Science Inc. All rights reserved.