Role of Immunohistochemistry in the Evaluation of Needle Core Biopsies in Adult Renal Cortical Tumors: An Ex Vivo Study

Multiple therapeutic options for renal tumors that are now available have put pathologists under increasing pressure to render diagnosis on limited material. Results on biopsies by hematoxylin and eosin (H&E) have historically not been encouraging. Currently, multiple immunohistochemical markers with differential expression in these renal tumors are available. We studied the utility of such markers on needle biopsies that were obtained ex vivo. After nephrectomy, two 18-guage cores were obtained and processed routinely. Expressions of carbonic anhydrase (CA) IX, CD117, &agr;-methylacyl-CoA racemase (AMACR), cytokeratin 7 (CK7), and CD10 were evaluated. Results, with or without immunostaining, were compared with the final nephrectomy diagnosis. We studied 145 tumors, including 119 renal cell carcinomas (83 clear cell, 18 papillary, 14 chromophobe, and 4 type unclassified), 11 oncocytomas, and 15 miscellaneous tumors. Adequate evaluable material was present in 123 (85%) cases. In such biopsies, 81% of cases were correctly classified by H&E alone, with correct diagnosis in 90% of cases in the most common tumor subtypes (clear cell, papillary and chromophobe renal cell carcinoma, and oncocytoma). By adding immunostains, the accuracy was 90% overall and 99% among the 4 most common subtypes. The following extent and patterns of immuneexpression were highly useful in the diagnoses: diffuse, membranous CAIX expression in clear cell renal cell carcinoma, diffuse positivity for AMACR in papillary renal cell carcinoma, distinct peripheral cytoplasmic accentuation for CD117 in chromophobe renal cell carcinoma, widespread and intense positivity for CK7 in chromophobe and papillary renal cell carcinoma, and diffuse membranous reactivity in clear cell and patchy/luminal in papillary renal cell carcinoma for CD10. In conclusion, utilizing immunostains improves classification of renal tumors on needle biopsy, which may be of particular help for pathologists with limited experience. Both extent and patterns must be considered for a definitive diagnosis.

[1]  D. E. Mills,et al.  Sternberg's Diagnostic Surgical Pathology , 2012 .

[2]  V. Reuter,et al.  Hypoxia‐inducible factor and mammalian target of rapamycin pathway markers in urothelial carcinoma of the bladder: possible therapeutic implications , 2011, BJU international.

[3]  P. Argani,et al.  Carbonic anhydrase IX expression in renal neoplasms: correlation with tumor type and grade. , 2010, American journal of clinical pathology.

[4]  D. Wood,et al.  Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions. , 2010, Urology.

[5]  A. Jemal,et al.  Cancer Statistics, 2010 , 2010, CA: a cancer journal for clinicians.

[6]  P. Russo.  Multi-modal treatment for metastatic renal cancer: the role of surgery , 2010, World Journal of Urology.

[7]  J. J. de la Rosette,et al.  Biopsy of a renal mass: where are we now? , 2009, Current opinion in urology.

[8]  C. Zielinski,et al.  Novel agents for renal cell carcinoma require novel selection paradigms to optimise first-line therapy. , 2009, Cancer treatment reviews.

[9]  D. Wood,et al.  Evolving role of renal biopsy in small renal masses. , 2009, Urologic oncology.

[10]  J. Wolf,et al.  Accuracy of percutaneous core biopsy in management of small renal masses. , 2009, Urology.

[11]  M. Blute,et al.  The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses , 2009 .

[12]  Paul Russo,et al.  Partial nephrectomy versus radical nephrectomy in patients with small renal tumors--is there a difference in mortality and cardiovascular outcomes? , 2009, The Journal of urology.

[13]  F. Smedts,et al.  Core biopsies of renal tumors: a study on diagnostic accuracy, interobserver, and intraobserver variability. , 2008, European urology.

[14]  Mesut Remzi,et al.  Diagnostic accuracy of computed tomography-guided percutaneous biopsy of renal masses. , 2008, European urology.

[15]  S. Campbell.  The paradigm shift in renal mass biopsy. , 2008, Clinical advances in hematology & oncology : H&O.

[16]  L. Qin,et al.  Carbonic Anhydrase IX Expression in Clear Cell Renal Cell Carcinoma: An Immunohistochemical Study Comparing 2 Antibodies , 2008, The American journal of surgical pathology.

[17]  J. Dekernion,et al.  Open Radical Nephrectomy for Localized Renal Cell Carcinoma , 2008 .

[18]  J. Long,et al.  [Value of percutaneous biopsy for solid renal tumours less than 4 cm in diameter based on a series of 53 cases]. , 2008, Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie.

[19]  T. Lebret,et al.  Percutaneous core biopsy for renal masses: indications, accuracy and results. , 2007, The Journal of urology.

[20]  Michael A S Jewett,et al.  Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. , 2007, The Journal of urology.

[21]  M. Beland,et al.  Diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses: should we biopsy all that are indeterminate? , 2007, AJR. American journal of roentgenology.

[22]  Elaine M Caoili,et al.  Renal mass core biopsy: accuracy and impact on clinical management. , 2007, AJR. American journal of roentgenology.

[23]  R. Motzer,et al.  Targeting von Hippel-Lindau Pathway in Renal Cell Carcinoma , 2006, Clinical Cancer Research.

[24]  R. Motzer,et al.  Treatment outcome for metastatic papillary renal cell carcinoma patients , 2006, Cancer.

[25]  M. Kattan,et al.  Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. , 2006, The Journal of urology.

[26]  Yao-Tseng Chen,et al.  Diagnosis of renal tumors on needle biopsy specimens by histological and molecular analysis. , 2006, The Journal of urology.

[27]  Victor E Reuter,et al.  The pathology of renal epithelial neoplasms. , 2006, Seminars in oncology.

[28]  G. Nabi,et al.  INCIDENTAL RENAL TUMOURS: THE FREQUENCY OF BENIGN LESIONS AND THE ROLE OF PREOPERATIVE CORE BIOPSY , 2006, BJU international.

[29]  R. Shah,et al.  Image-guided biopsy in the evaluation of renal mass lesions in contemporary urological practice: indications, adequacy, clinical impact, and limitations of the pathological diagnosis. , 2005, Human pathology.

[30]  J. Lam,et al.  Role of molecular markers in the diagnosis and therapy of renal cell carcinoma. , 2005, Urology.

[31]  A. Folpe,et al.  Distribution of Cytokeratins and Vimentin in Adult Renal Neoplasms and Normal Renal Tissue: Potential Utility of a Cytokeratin Antibody Panel in the Differential Diagnosis of Renal Tumors , 2005, The American journal of surgical pathology.

[32]  J. Lam,et al.  G250: A carbonic anhydrase IX monoclonal antibody , 2005, Current oncology reports.

[33]  M. Amin,et al.  An immunohistochemical approach to the differential diagnosis of renal tumors. , 2005, Seminars in diagnostic pathology.

[34]  P. Tamboli,et al.  Chromophobe renal cell carcinoma: a comparative study of histological, immunohistochemical and ultrastructural features using high throughput tissue microarray , 2004, Histopathology.

[35]  A. Lazaris,et al.  Hypoxia-inducible factor 1 alpha expression correlates with angiogenesis and unfavorable prognosis in bladder cancer. , 2004, European urology.

[36]  Y. Neuzillet,et al.  Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. , 2004, The Journal of urology.

[37]  A. Harris,et al.  Hypoxia Inducible Carbonic Anhydrase IX, Marker of Tumour: Hypoxia, Survival Pathway and Therapy Target , 2004, Cell cycle.

[38]  J. Cheville,et al.  Comparisons of Outcome and Prognostic Features Among Histologic Subtypes of Renal Cell Carcinoma , 2003, The American journal of surgical pathology.

[39]  M. Blute,et al.  Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. , 2003, The Journal of urology.

[40]  M. Kattan,et al.  Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome. , 2002, Urology.

[41]  Paul Russo,et al.  Mode of presentation of renal cell carcinoma provides prognostic information. , 2002, Urologic oncology.

[42]  M. Mathers,et al.  Cytokeratin 7: a useful adjunct in the diagnosis of chromophobe renal cell carcinoma , 2002, Histopathology.

[43]  Mahul B. Amin,et al.  Prognostic Impact of Histologic Subtyping of Adult Renal Epithelial Neoplasms: An Experience of 405 Cases , 2002, The American journal of surgical pathology.

[44]  F. Marshall,et al.  Expression profiling of renal epithelial neoplasms: a method for tumor classification and discovery of diagnostic molecular markers. , 2001, The American journal of pathology.

[45]  C. Siegel.  Accuracy of diagnosis by guided biopsy of renal mass lesions classified indeterminate by imaging studies. , 2001, The Journal of urology.

[46]  P. Russo,et al.  Surgical management of renal tumors 4 cm. or less in a contemporary cohort. , 2000, The Journal of urology.

[47]  A. Renshaw,et al.  Use of antibodies to RCC and CD10 in the differential diagnosis of renal neoplasms. , 2000, The American journal of surgical pathology.

[48]  V. Reuter.  Renal tumors exhibiting granular cytoplasm. , 1999, Seminars in diagnostic pathology.

[49]  M. Harisinghani,et al.  Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. , 1999, The Journal of urology.

[50]  S. Tickoo,et al.  Discriminant nuclear features of renal oncocytoma and chromophobe renal cell carcinoma. Analysis of their potential utility in the differential diagnosis. , 1998, American journal of clinical pathology.

[51]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.

[52]  O. Machado.  [Tumors of the kidney]. , 1958, Revista brasileira de cirurgia.