Platinum Priority – Collaborative Review – Kidney Cancer Editorial by Tobias Klatte on pp. 505–506 of this issue Rationale for Percutaneous Biopsy and Histologic Characterisation of Renal Tumours Alessandro Volpe a, *, Antonio Finelli b , Inderbir S. Gill c , Michael A.S. Jewett b , Guido Martignoni d , Thomas J. Polascik e , Mesut Remzi f , Robert G. Uzzo g a Department of Urology, University of Eastern Piedmont, Maggiore della Carita ` Hospital, Novara, Italy; b Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada; c USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; d Department of Pathology and Diagnostics, Anatomia Patologica, University of Verona, Verona, Italy; e Division of Urology, Duke Cancer Institute, Durham, NC, USA; f Department of Urology, Landesklinikum Weinviertel–Korneuburg, Korneuburg, Austria; g Department of Urologic Oncology, Fox Chase Cancer Centre, Philadelphia, PA, USA EUROPEAN UROLOGY 62 (2012) 491–504 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted May 3, 2012 Published online ahead of print on May 11, 2012 Keywords: Needle core biopsy Renal mass Renal cell carcinoma Diagnosis Prognosis Molecular markers Cytogenetic markers Abstract Context: The use of percutaneous biopsy of renal tumours has been traditionally reserved for selected cases because of uncertainties regarding its safety, accuracy, and clinical utility. With the adoption of modern biopsy techniques and increasing expertise in interpreting biopsy specimens, renal tumour biopsy today has limited morbidity and allows histologic diagnosis in the majority of cases in centres with expertise. Objective: To review the current rationale, indications, and outcomes of percutaneous biopsies and histologic characterisation of renal tumours. Evidence acquisition: We conducted a systematic review of English-language articles on percutaneous biopsies of renal tumours published between January 1999 and December 2011 using the Medline, Embase, and Web of Science databases. One hundred twelve articles were selected with the consensus of all authors and analysed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Evidence synthesis: In recent years, the increasing incidence of incidental small renal masses (SRMs), the development of conservative and minimally invasive treatments for low-risk renal cell carcinoma (RCC), and the discovery of novel targeted treatments for metastatic disease have provided the rationale for expanding the indications for renal tumour biopsy. Percutaneous biopsy for diagnostic assessment of SRMs can avoid unnecessary surgeries and support treatment decisions, especially in patients at high surgical risk. Biopsies can confirm histologic success after thermal ablation of SRMs and support the selection of the appropriate systemic therapy for metastatic RCC. There is increasing evidence that further diagnostic and prognostic information can be obtained from renal tumour biopsies with the use of immunohistochemistry, cytogenetic and molecular analysis, and high-throughput gene expression profiling. Conclusions: Percutaneous biopsies have increasing indications and can significantly contribute to clinical management of renal tumours but are still underutilised in clinical practice. Further research is needed to define optimal and standardised patterns of biopsy and improve the accuracy of biopsies to determine tumour histology. Molecular and genetic analysis of biopsy specimens can provide additional information to support patient counselling and treatment decision making. # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Division of Urology, Maggiore della Carita ` Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100 Novara, Italy. Tel. +39 0321 373 3201; Fax: +39 0321 373 3763. E-mail address: alessandro.volpe@med.unipmn.it (A. Volpe). 0302-2838/$ – see back matter # 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.eururo.2012.05.009