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INTRODUCTION AND OBJECTIVE:Renal angiomyolipoma (AML) are rare tumors and few data are available to compare treatments for patients with large or enlarging tumors. The objective of this project was...

INTRODUCTION AND OBJECTIVES:Shared decision making is important for patients who are considering treatment of small renal masses (SRM). The purpose of this study was to compare patient's opinions w...

Purpose To demonstrate the feasibility of Robotically Assisted Sonic Therapy (RAST)—a noninvasive and nonthermal focused ultrasound therapy based on histotripsy—for renal ablation in a live porcine model. Materials and Methods RAST ablations (n = 11) were performed in 7 female swine: 3 evaluated at 1 week (acute) and 4 evaluated at 4 weeks (chronic). Treatment groups were acute bilateral (3 swine, 6 ablations with immediate computed tomography [CT] and sacrifice); chronic single kidney (3 swine, 3 ablations; CT at day 0, week 1, and week 4 after treatment, followed by sacrifice); and chronic bilateral (1 swine, 2 ablations). Treatments were performed using a prototype system (VortxRx; HistoSonics, Inc) and targeted a 2.5-cm-diameter sphere in the lower pole of each kidney, intentionally including the central collecting system. Results Mean treatment time was 26.4 minutes. Ablations had a mean diameter of 2.4 ± 0.3 cm, volume of 8.5 ± 2.4 cm3, and sphericity index of 1.00. Median ablation volume decreased by 96.1% over 4 weeks. Histology demonstrated complete lysis with residual blood products inside the ablation zone. Temporary collecting system obstruction by thrombus was observed in 4/11 kidneys (2 acute and 2 chronic) and resolved by 1 week. There were no urinary leaks, main vessel thromboses, or adjacent organ injuries on imaging or necropsy. Conclusions In this normal porcine model, renal RAST demonstrated complete histologic destruction of the target renal tissue while sparing the urothelium.

INTRODUCTION AND OBJECTIVES: Standard percutaneous renal mass biopsy is prone to sampling error in large heterogeneous renal masses, which increases the risk for non-diagnostic results or failure to detect poor prognostic features. The purpose of this study was to compare the accuracy of percutaneous biopsy for large renal masses using a modified multi-quadrant technique (qBx) to standard biopsy technique. METHODS: Clinical and pathologic data for all patients with cT2 renal masses who received percutaneous biopsy using standard or modified techniques at a single institution over a five year period (2009 e 2014) were reviewed with IRB approval. The qBx technique includes multiple core biopsies from at least four separate, solid enhancing areas within the tumor. Standard technique obtained core samples from < 4 areas within the tumor. An expert genitourinary pathologist (WH) performed a blinded review of each biopsy core. RESULTS: In patients with cT2 renal masses, 110 biopsies were performed in 105 patients (45 standard technique and 65 qBx). Mean clinical tumor size was 10 cm (IQR 8-13). Biopsy was nondiagnostic in 5/45 (11.1%) standard and 0/65 (0%) qBx. Nephrectomy was performed after 66 biopsies (21 standard and 45 qBx). When comparing the concordance of biopsy pathology to nephrectomy specimens, biopsy correctly predicted the type of renal neoplasm in 17/ 18 (94.4%) standard biopsies and 45/45 (100%) qBx. In 57 RCC tumors, grade was assigned for both biopsy and nephrectomy specimens. Tumor grade was concordant in 2/14 (14.3%) of standard biopsies and 27/43 (62.8%) qBx. Sarcomatoid de-differentiation was identified in 16/88 (18.2%) of large RCC tumors studied. Sarcomatoid features were identified from biopsy in 10/16 (62.5%) tumors. The ability to identifying sarcomatoid features was higher using multi-quadrant technique compared to the standard technique, 8/10 (80.0%) vs 2/6 (33.3%). One patient who had a biopsy using the standard technique required hospital admission for hemorrhage. No complications were reported in patients when using the qBx technique. CONCLUSIONS: Multi-quadrant biopsy technique increases diagnostic accuracy in large renal tumors.

The American Cancer Society-National Prostate Cancer Detection Project is a prospective, comparative study of a cohort of 2,999 men 55 to 70 years old not suspected on entry of having prostate cancer. A total of 164 prostate cancers is available from this project for analysis. A small proportion of tumors detected were advanced in terms of the clinical stage at diagnosis. Cancer detected by digital rectal examination tended to be more advanced than that found on the basis of only transrectal ultrasound or prostate specific antigen (PSA). A large proportion of patients received curative therapy involving radical prostatectomy in 67.1% and radiotherapy in 18.3%. Of 103 men presumed to have organ confined disease and treated by prostatectomy 64 (37.9%) actually had locally extensive cancer pathologically. PSA level and PSA density were associated with the detection of organ confined cancer but several advanced tumors had PSA levels in the normal range. Age referenced PSA, compared to conventional sta...