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Objectives <p>Image-guided thermal ablation is a guideline-supported treatment for small renal tumors. While biopsy is recommended, the optimal timing relative to ablation remains undefined. Pre-ablation biopsy may complicate ablation through hemorrhage, impaired target visualization, and potential tumor seeding. Post-cryoablation biopsy has been described in a small cohort of patients, but reproducibility has not been established. This study evaluated the diagnostic performance and clinical outcomes of renal mass biopsy performed immediately after cryoablation in a single session.</p> Methods <p>This retrospective, single-center study included patients who underwent image-guided percutaneous cryoablation followed by immediate post-ablation core needle biopsy, performed at operator discretion, between December 2018 and April 2025. After active or passive thaw and probe removal, at least two 18-gauge core biopsy samples were obtained per lesion using a coaxial needle. Specimens were formalin-fixed and reviewed by pathology. Outcomes included specimen adequacy, histopathologic diagnosis, adverse events, imaging response, and tumor recurrence or seeding. Follow-up imaging and labs were performed at 3 and 6 or 9 months, then annually.</p> Results <p>Twenty-six solid enhancing renal masses (mean size 2.5&#xa0;cm, range 1.4–4.7&#xa0;cm) in 24 patients were included. All biopsy specimens were diagnostic with histologic diagnoses including renal cell carcinoma (RCC, <i>n</i> = 19), oncocytoma (<i>n</i> = 6), and metanephric adenoma (<i>n</i> = 1), with RCC subtypes including clear cell, papillary, chromophobe, sarcomatoid, and mixed histology. Complications were limited to the immediate post-procedural period, with no delayed adverse events or chronic sequelae. All lesions demonstrated complete radiographic response on 3-month follow-up imaging. There were no cases of tumor recurrence or seeding observed over a median follow-up of 1,415 days.</p> Conclusion <p>Immediate post-cryoablation renal mass biopsy is diagnostically reliable and may provide benefit in clinical practice.</p>

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Immediate percutaneous renal mass biopsy following cryoablation: validation of diagnostic performance and clinical outcomes

  • 期刊论文

  • 发表日期：

    2026年6月20日

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  • Fatima Islam,
  • Beau Toskich,
  • David Thiel,
  • Gregory Frey,
  • Zlatko Devcic,
  • Andrew Lewis

摘要

Objectives

Image-guided thermal ablation is a guideline-supported treatment for small renal tumors. While biopsy is recommended, the optimal timing relative to ablation remains undefined. Pre-ablation biopsy may complicate ablation through hemorrhage, impaired target visualization, and potential tumor seeding. Post-cryoablation biopsy has been described in a small cohort of patients, but reproducibility has not been established. This study evaluated the diagnostic performance and clinical outcomes of renal mass biopsy performed immediately after cryoablation in a single session.

Methods

This retrospective, single-center study included patients who underwent image-guided percutaneous cryoablation followed by immediate post-ablation core needle biopsy, performed at operator discretion, between December 2018 and April 2025. After active or passive thaw and probe removal, at least two 18-gauge core biopsy samples were obtained per lesion using a coaxial needle. Specimens were formalin-fixed and reviewed by pathology. Outcomes included specimen adequacy, histopathologic diagnosis, adverse events, imaging response, and tumor recurrence or seeding. Follow-up imaging and labs were performed at 3 and 6 or 9 months, then annually.

Results

Twenty-six solid enhancing renal masses (mean size 2.5 cm, range 1.4–4.7 cm) in 24 patients were included. All biopsy specimens were diagnostic with histologic diagnoses including renal cell carcinoma (RCC, n = 19), oncocytoma (n = 6), and metanephric adenoma (n = 1), with RCC subtypes including clear cell, papillary, chromophobe, sarcomatoid, and mixed histology. Complications were limited to the immediate post-procedural period, with no delayed adverse events or chronic sequelae. All lesions demonstrated complete radiographic response on 3-month follow-up imaging. There were no cases of tumor recurrence or seeding observed over a median follow-up of 1,415 days.

Conclusion

Immediate post-cryoablation renal mass biopsy is diagnostically reliable and may provide benefit in clinical practice.