U J All Final for WEB.pdf 780 | 1 Division of Pediatric Urology, Chil- dren’s Medical Center of Dallas and University of Texas Southwestern Medical Center, Dallas, Texas 2 Division of Urologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas 3 Division of Pediatric Hematology and Oncology, Children’s Medical Center of Dallas and University of Texas Southwestern Medical Center, Dallas, Texas 4 Department of Pathology, Chil- dren’s Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas Nicholas G. Cost,1,2 Candace F. Granberg,1 Bruce J. Schlomer,1 Jonathan E. Wickiser,3 Patricio C. Gargollo,1 Linda A. Baker,1 Dinesh Rakheja4 Single Institution Experience with Tru-Cut Renal Mass Biopsy for Diagnosing Wilms Tumor Corresponding Author: Nicholas G. Cost, MD Division of Pediatric Urology, Cincin- nati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 5037, Cincinnati, Ohio 45229, USA Tel: +513 363 0773 Fax: +513 636 6753 E-mail: nicholas.cost@sbcglobal.net Received January 2012 Accepted October 2012 Purpose: chemotherapy. Materials and Methods: pathology. Results: - no patients have had local or regional recurrence. Conclusion: - Keywords: pediatrics, Wilms tumor, nephroblastoma, kidney neoplasms, diagnosis UROLOGICAL ONCOLOGY Urological Oncology 781Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Tru-Cut Renal Mass Biopsy for Wilms Tumor | Cost et al INTRODUCTION Wilms tumor (WT) is the most common renal ma-lignancy in children and the fourth most com-mon childhood cancer. In North America, - strategy is used by the International Society of Pediatric On- chemotherapy, after radiographic diagnosis. protocol, chemotherapy includes over-treating benign, non-WT renal - - cyclines), and the reduced need for radiation. Furthermore, advocates of minimally-invasive surgery and nephron- sparing surgery(7) recognize that pre-surgical chemotherapy could increase the percentage of children eligible for these approaches. - CSG) has recently investigated the timing of chemotherapy - ly diagnosed, unilateral, and non-metastatic renal tumors to Their solution to paradigm is not routinely used in North America and current COG recommendations mandate upstaging in unilateral cas- es undergoing biopsy. Given the various risks and potential - cutaneous biopsy for pediatric renal masses to evaluate its diagnostic ability and safety. CASE REVIEW - resection of the renal mass. The biopsy and surgical resection - months). One patient had a prior liver transplant, and imaging done for elevated transaminases demonstrated a renal mass suspicious lymphoproliferative disorder (PTLD), the patient under- PTLD, saving them from un-necessary nephrectomy. Another patient had a percutaneous biopsy performed for a possible renal abscess versus tumor. After the pathology dem- - - same operative session as needle biopsy due to inconclusive patient did not undergo nephrectomy due to disease progres- sion during the time from biopsy to planned nephrectomy. The remaining 6 patients had bilateral renal masses. - section after percutaneous biopsy in order to correlate the read as WT versus hyperplastic nephrogenic rests. No biopsy to produce a median of 3 (2 to 6) evaluable specimens for after the biopsy and no patients have had a local or regional 782 | months) post-biopsy. DISCUSSION Despite the potential advantages of pre-surgical chemo- therapy for WT, the concern for inappropriately treating paradigm. Previous investigators have studied pre-therapy - non-WT pathology. Therefore, they propose that a pre- - dates for pre-surgical chemotherapy. risks of tumor spillage and possible biopsy-tract seeding. For these reasons, the current COG protocols mandate upstaging of cases undergoing percutaneous biopsy. Thus, despite using biopsy to achieve a goal of decreased mor- - plications. To investigate this, the UKCCSG has studied a masses suspected to be WT. Their results indicate that percutaneous biopsy of such masses is safe and effective. - ous needle biopsy of suspicious renal masses to assess both its safety and diagnostic ability. safe and accurate in our small series. To determine the accu- resection. In each case, the diagnosis of WT from the biopsy - tion. - - ever, there are risks and these must be highlighted. The im- mediate risks include bleeding, infection, and pain. The more dreaded long-term complications are needle-tract tumor seed- ing or tumor spillage and increased local disease recurrence. - ture of needle tract recurrence, the risk must not be ignored. To put this into perspective, the rate of intra-operative tu- mor rupture in the immediate surgery arm of the same study - in event-free or overall survival. Furthermore, they achieved immediate surgery group. - perience may not be applicable to a generalized population CONCLUSION In our series, Tru-cut renal mass biopsy reliably and safely diagnosed WT. Using such a pre-therapy biopsy paradigm may aid in the appropriate selection of candidates for pre- this aim to assess its ultimate utility and safety. CONFLICT OF INTEREST None declared. REFERENCES 1. Gurney JG, Severson RK, Davis S, Robison LL. Incidence of cancer in children in the United States. Sex-, race-, and 1-year age-specific rates by histologic type. Cancer. 1995;75:2186-95. 2. Grovas A, Fremgen A, Rauck A, et al. The National Cancer Data Base report on patterns of childhood cancers in the United States. Cancer. 1997;80:2321-32. Urological Oncology 783Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L Tru-Cut Renal Mass Biopsy for Wilms Tumor | Cost et al 3. Kaste SC, Dome JS, Babyn PS, et al. Wilms tumour: prognos- tic factors, staging, therapy and late effects. Pediatr Radiol. 2008;38:2-17. 4. Nakamura L, Ritchey M. Current management of wilms' tumor. Curr Urol Rep. 2010;11:58-65. 5. Barber TD, Wickiser JE, Wilcox DT, Baker LA. Prechemother- apy laparoscopic nephrectomy for Wilms' tumor. J Pediatr Urol. 2009;5:416-9. 6. Duarte RJ, Denes FT, Cristofani LM, Odone-Filho V, Srougi M. Further experience with laparoscopic nephrectomy for Wilms' tumour after chemotherapy. BJU Int. 2006;98:155-9. 7. Cost NG, Lubahn JD, Granberg CF, et al. Oncologic out- comes of partial versus radical nephrectomy for unilateral Wilms tumor. Pediatr Blood Cancer. 2012;58:898-904. 8. Mitchell C, Pritchard-Jones K, Shannon R, et al. Immediate nephrectomy versus preoperative chemotherapy in the management of non-metastatic Wilms' tumour: results of a randomised trial (UKW3) by the UK Children's Cancer Study Group. Eur J Cancer. 2006;42:2554-62. 9. Cheng E, Fustino N, Klesse L, Chinnakotla S, Sanghavi R. Post-transplant lymphoproliferative disorder resembling Wilms tumor. Diagnostic dilemma: renal biopsy or ne- phrectomy? Pediatr Transplant. 2011;15:E187-91. 10. Vujanic GM, Kelsey A, Mitchell C, Shannon RS, Gornall P. The role of biopsy in the diagnosis of renal tumors of child- hood: Results of the UKCCSG Wilms tumor study 3. Med Pediatr Oncol. 2003;40:18-22. 11. Lee IS, Nguyen S, Shanberg AM. Needle tract seed- ing after percutaneous biopsy of Wilms tumor. J Urol. 1995;153:1074-6. 12. Shet T, Viswanathan S. The cytological diagnosis of paediat- ric renal tumours. J Clin Pathol. 2009;62:961-9. 13. Aslam A, Foot A, Spicer R. Needle track recurrence after biopsy of non-metastatic Wilms tumour. Pediatr Surg Int. 1996;11:416-7.