title: Real-time 3D fluoroscopy-guided large core needle biopsy of renal masses: a critical early evaluation according to the IDEAL recommendations.
abstract: BACKGROUND
  Three-dimensional (3D) real-time fluoroscopy cone beam CT is a promising new technique for image-guided biopsy of solid tumors. We evaluated the technical feasibility, diagnostic accuracy, and complications of this technique for guidance of large-core needle biopsy in patients with suspicious renal masses.
  
  
  METHODS
  Thirteen patients with 13 suspicious renal masses underwent large-core needle biopsy under 3D real-time fluoroscopy cone beam CT guidance. Imaging acquisition and subsequent 3D reconstruction was done by a mobile flat-panel detector (FD) C-arm system to plan the needle path. Large-core needle biopsies were taken by the interventional radiologist. Technical success, accuracy, and safety were evaluated according to the Innovation, Development, Exploration, Assessment, Long-term study (IDEAL) recommendations.
  
  
  RESULTS
  Median tumor size was 2.6 (range, 1.0-14.0) cm. In ten (77%) patients, the histological diagnosis corresponded to the imaging findings: five were malignancies, five benign lesions. Technical feasibility was 77% (10/13); in three patients biopsy results were inconclusive. The lesion size of these three patients was <2.5 cm. One patient developed a minor complication. Median follow-up was 16.0 (range, 6.4-19.8) months.
  
  
  CONCLUSIONS
  3D real-time fluoroscopy cone beam CT-guided biopsy of renal masses is feasible and safe. However, these first results suggest that diagnostic accuracy may be limited in patients with renal masses<2.5 cm.
authors.affiliation: Department of Urology, University Medical Center Utrecht, C04.236, Postbox 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Stephanie G C
authors.initials: SG
authors.lastname: Kroeze
authors.forename: Merel
authors.initials: M
authors.lastname: Huisman
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Diest
authors.forename: J L H
authors.initials: JL
authors.lastname: Ruud Bosch
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014963:X-Ray Intensifying Screens