Quality statement 2: Renal biopsy for small renal lesions
Quality statement
Adults with a suitable renal lesion 4 cm in diameter or smaller have a renal biopsy to help confirm the diagnosis.
Rationale
The results of a renal biopsy for a suitable small renal lesion will confirm or rule out a diagnosis of renal cell carcinoma (RCC) and inform management options. When offering renal biopsy, healthcare professionals should explain the procedure, including its benefits, to support informed decision making. A biopsy may prevent overtreatment of benign renal lesions or low-risk malignant masses. This will particularly benefit adults who have a high risk of morbidity or mortality from radical treatment, such as partial or total nephrectomy.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of adults with a suitable renal lesion 4 cm in diameter or smaller who have a renal biopsy to help confirm the diagnosis.
Numerator – the number in the denominator who have a renal biopsy to help confirm the diagnosis.
Denominator – the number of adults with a suitable renal lesion 4 cm in diameter or smaller.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. The National Kidney Cancer Audit - National Cancer Audit Collaborating Centre's State of the Nation Report performance indicator dashboard presents data on the percentage of people diagnosed with renal cancer 4 cm or smaller, or a renal cancer that is Tumour Node Metastasis (TNM) stage T1aN0M0 who have had a renal biopsy. This data does not capture renal lesions that were not diagnosed as cancer or the suitability of the renal lesion for biopsy. It is not expected that achievement will be 100%. This is because a renal biopsy will not be suitable for all adults with such a renal lesion, and some adults will choose not to have a biopsy. Commissioners and services may wish to focus on local uptake of biopsy compared with the national average.
What the quality statement means for different audiences
Service providers (such as secondary or tertiary care services) ensure that systems are in place so that adults with a suitable renal lesion 4 cm in diameter or smaller can have a renal biopsy to help confirm the diagnosis. They ensure that healthcare professionals who offer biopsy are aware of all aspects of biopsy, including its benefits, so that adults can make an informed decision when renal biopsy is offered.
Healthcare professionals (such as consultants, clinical nurse specialists and interventional radiologists) offer renal biopsy to adults with a suitable renal lesion 4 cm in diameter or smaller to help confirm the diagnosis. They explain all aspects of biopsy, including its benefits, when offering the procedure.
Commissioners ensure that services can provide renal biopsy for adults with a suitable renal lesion 4 cm in diameter or smaller to help confirm the diagnosis.
Adults with a suitable small kidney lesion are offered a renal biopsy (a procedure where a small tissue sample is taken from the lesion to be looked at under a microscope) to help confirm their diagnosis and inform management options. They are supported to make an informed decision through a discussion with their healthcare professional about all aspects of biopsy, including its benefits. Renal biopsy is not an option for everyone. For example, biopsy will not be offered for renal lesions in a location that is not accessible for biopsy, for cysts that do not have a sufficient solid component to do a biopsy, or when the results would not change management.
Source guidance
Kidney cancer: diagnosis and management. NICE guideline NG256 (2026), recommendations 1.3.1 and 1.3.3
Definitions of terms used in this quality statement
Suitable renal lesion for biopsy
A renal lesion with a solid component that is large enough to get a tissue sample from. Renal biopsy should not be offered if:
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it is not going to change management
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the renal lesion has grown into the renal vein or inferior vena cava and the person is a candidate for surgical treatment
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getting a tissue sample is not possible (for example, the renal lesion is in a location that is not accessible for biopsy).
[NICE's guideline on kidney cancer, recommendations 1.3.1 and 1.3.3]
Equality and diversity considerations
All adults with a suitable renal lesion should be offered a renal biopsy regardless of where they live, even if they need to travel to another hospital to have the procedure. Adults should be made aware that they may be eligible for the NHS healthcare travel costs scheme.