At the end of the session, the participants will be able to:
Kidney cancer is one of the top 10 prevalent cancers in North America. The incidence of kidney cancer is increasing in the last few decades. Recently, the International Society of Urological Pathology (ISUP) identified a number of significant inconsistencies and discrepancies between pathologists regarding the reporting of kidney cancer. Furthermore, accumulating research in the field identified a number of new clinical and molecular parameters that can improve disease management. A number of international work groups were assembled to address the recent advances in this field, and in 2012, the annual meeting of the ISUP was focused on developing consensus recommendations for handing and reporting kidney cancer specimens that are consistent among pathologists. These recommendations will be published in the next few months. Moreover, a number of new entities are officially recognized during that meeting. The purpose of this workshop is to highlight the recent changes that were implemented by the ISUP especially the new and modified items that will help to reach much higher levels of consistency and uniformity among pathologists in reporting a kidney cancer.
Approximately 60-70% of renal masses < 4 cm in size are found incidentally when ultrasound examinations are performed for reasons other than signs/symptoms referable to the kidneys. As the use of ultrasound examinations by primary care physicians increases, there will be an expected increase in the incidental detection of these small renal masses (SRM). Autopsy and partial nephrectomy data demonstrate that 20% of SRM’s will be benign (typically oncocytoma or angiomyolipoma) requiring no immediate treatment. Slow growth and low progression rates of most low grade renal cancers make active surveillance with delayed intervention a viable management option, particularly for elderly patients with multiple co-morbidities. As such, needle core biopsies of these lesions can be extremely helpful in developing a management plan for the incidentally found SRM. Pathologists faced with such biopsies appreciate that there is a learning curve associated with reporting them. The objectives for this portion of the course are: to review the success rates for needle biopsies of SRM’s in terms of diagnostic yield and concordance with the final pathology in nephrectomy/partial nephrectomy specimens, to understand the pitfalls associated with limited sampling provided by needle biopsies and to understand the appropriate use and limitations of immunohistochemistry when attempting to classify renal neoplasms in needle biopsies.