Renal Oncocytoma - Are There Sufficient Grounds To Consider Surveillance Following Prenephrectomy Histologic Diagnosis?

Main Category: Urology / Nephrology
Article Date: 21 Jun 2010 - 6:00 PDT


UroToday.com - Oncocytoma is a benign tumor originating from the distal tubule. Despite the benign nature of this tumor, it is resected in the vast majority of cases. The issue of pre-nephrectomy renal biopsy as a way to differentiate between benign and malignant renal tumors was addressed in the past and did not become common practice. The reason for this is threefold. First, the natural history of this tumor is not well defined and thus the implications of leaving an oncocytoma behind are not known.

Second, contemporary pathological examination (after renal biopsy) and imaging modalities cannot differentiate between oncocytoma and several subtypes of renal cell carcinoma (RCC), especially chromophobe RCC. And last, even if the natural history was fully known and pathological examination was exact, hybrid oncocytoma-RCC tumors remains a major setback for renal biopsy.

However, a change in this approach is beginning to take hold. More often patients are reluctant to undergo, and physicians are uncomfortable to perform, any kind of nephrectomy without prior tissue diagnosis. It is not rare to find oneself in the situation of resecting a kidney only to find that the tumor was benign. Improved renal imaging (either computer tomography or magnetic resonance) allow for more accurate diagnosis and easier follow-up of patients that are not operated upon. Technological advances such as introducers make renal biopsies safer and with less disruption of the tissue architecture, thus allowing a more accurate pathological diagnosis.

Therefore a time when no kidney will be resected without prior tissue diagnosis is approaching. It is therefore an exciting time, as such a change may take the common urological practice to new directions.

Written by Miki Haifler, MD, and Amnon Zisman, MD, MHA, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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