Heterogeneity and renal mass biopsy: a review of its role and reliability.

摘要: Increased abdominal imaging has led to an increase in the detection of incidental small renal mass (SRM). With increasing recognition that malignant potential SRMs is heterogeneous, ranging from benign (15%-20%) aggressive (20%), enthusiasm for more conservative management strategies elderly and infirmed, such as active surveillance (AS), have grown considerably. As SRM evolves incorporate ablative techniques AS low risk disease, role biopsy (RMB) help guide individualized therapy evolving. Historically, RMB was limited evaluation suspected metastatic abscess, or lymphoma. However, contemporary era, grown, most notably identify patients who harbor lesions whom treatment, particularly frail, may be avoided. When performing a initial clinical decision making small, localized tumors, relevant questions are often relegated proof malignancy documentation (if possible) grade. significant intratumoral heterogeneity been identified clear cell carcinoma (ccRCC) lead underestimation genetic complexity tumor when single-biopsy procedures used. Heterogeneous genomic landscapes branched parallel evolution ccRCCs with spatially separated subclones creates illusion clonal dominance assessed by single biopsies raises important regarding how tumors can optimally sampled whether future evolutionary branches might predictable ultimately targetable. This work profound concerning landscape cancer affect, possibly confound, targeted diagnostic therapeutic interventions. In this review, we discuss current RMB, implications on accuracy, highlight promising directions.