Single-Centre Retrospective Analysis of the Diagnostic Yield and Safety of Image-Guided Percutaneous Core-Needle Biopsy of Renal and Perirenal Masses

Abstract

Background. Image-guided percutaneous core-needle biopsy is increasingly used to characterise renal and perirenal masses before definitive management, but its performance in mixed paediatric-and-adult referral practice, particularly in resource-limited settings, is not well described.

Objective. To determine the diagnostic yield and safety of image-guided percutaneous core-needle biopsy of renal and perirenal masses in a single interventional radiology service.

Methods. We retrospectively reviewed 25 consecutive image-guided percutaneous core biopsies of renal and perirenal masses performed in one service, with histopathology reported at two reference laboratories, between December 2021 and September 2024. Procedural details, tissue adequacy, immunohistochemistry use, final histological diagnosis and complications were recorded. Diagnostic yield was defined a priori as a biopsy providing a specific histological diagnosis sufficient to direct management; a broader yield estimate additionally counted biopsies that confirmed a neoplasm without finalising the entity. Proportions are reported with 95% Wilson confidence intervals (CI).

Results. The cohort comprised 17 children and 8 adults (15 male, 10 female); median lesion size was 7.0 cm (range 3.3–14.4). All biopsies used an 18-gauge semi-automatic needle; 20 (80%) were ultrasound-guided and 5 (20%) CT-guided, with a median of 3 passes (range 2–6). Tissue was adequate in 20/25 (80%) and immunohistochemistry was required in 24/25 (96%). A specific histological diagnosis was achieved in 18/25 (72.0%; 95% CI 52.4–85.7%); when biopsies confirming a neoplasm without a final entity were included, the yield rose to 22/25 (88.0%; 95% CI 70.0–95.8%). Three biopsies (12.0%; 95% CI 4.2–30.0%) were non-diagnostic or preliminary. Wilms tumour (n=9) and neuroblastoma (n=4) predominated in children; clear cell renal cell carcinoma and other adult malignancies were seen in adults. Complications occurred in 8/25 (32.0%; 95% CI 17.2–51.6%) and were exclusively minor (SIR class A–B): self-limiting pain (n=4), focal haematoma (n=3) and a vasovagal episode (n=1); there were no major complications, transfusions, embolisations, tract seeding or procedure-related deaths.

Conclusions. In this single-centre series, image-guided percutaneous core biopsy of renal and perirenal masses achieved a diagnostic yield comparable to published adult experience and was safe, with only minor complications. Near-universal reliance on immunohistochemistry underscores that such a service requires ready access to a full ancillary pathology panel.