What size does a suspicious lesion need to be for a biopsy?

Hi Lee,

That is indeed very small, by renal lesion standards. When I had mine (a bit bigger than that when first discovered), biopsy wasn't even in the equation. They judged it by the Bosniak scale. Ie, what it actually looked like on the scan.

However, I don't think this will actually rule out cancer, alas. It is more designed to rule it in, by what I gather. (Bosniak i and ii are highly unlikely to be cancerous but again, they don't technically rule it out even so)

That seems rather unfair to me to ask for this lesion to be ruled out as cancerous. I didn't think it was possible to categorically say that a lesion is not cancerous. The modern way seems to be looking for cancer everywhere possible - which is good in one sense, as many are caught early and are curable, but on another level it feels to me like they are always focusing on looking for the worst case scenario, ie cancer. 

I think your only way forward is to push for a biopsy, regardless of what your team says - explain to them why. I fail to see why 8mm is too small to biopsy...if it's large enough to see, then surely it can be biopsied? I wonder if they are trying to save manpower and perhaps don't fully realise the implications to you of the trial going ahead or not, if you don't have answers?

You may end up discovering through biopsy that it is cancerous, in which case the trial presumably won't be possible anyway - but at least, you would know. So talk with your team and see if they will do it under the circumstances of your needing to know, because I don't really see why they cannot when things like moles, for example, which are often smaller than 8mm, can be biopsied. I have no medical knowledge however, so please just take this forward and ask a few questions to those who have the knowledge.

Good luck - hope you can resolve this catch-22.

 Maite Thank you.  I spoke to the renal nurse today and asked for the Bosniak score but that hasn’t been recorded from any of the scans. 

She said biopsies on such small lesions are unusual because of the risks involved but can be done if there’s a clinical need. She will put it to the MDT team next week.  I also asked about ablation so hope to hear more next week. 

it does seem like this will all be outside the timescale for the trial though. Keeping for some good news soon. 

I'm sorry that it's probably not going to be resolved in time for your trial. I would say there is indeed a "clinical need" under the circumstances, as it's not just about your kidney lesion but more importantly about your colorectal cancer. However, you are dealing presumably with two separate departments here (renal, and colorectal) and they are each looking at your condition as it applies to them, without co-referencing the two.

Keeping everything crossed for you that this will turn out well. 

Thanks Maite   Yes 2 different departments at my local hospital plus the Royal Marsden so I feel I have to be on top of them all.  No news yet but trying to be hopeful x