***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: INTRODUCTION Ablative therapy is increasing for the management of small renal masses . Laparoscopic as well as percutaneous cryotherapy and radiofrequency ablation ( RFA ) have been utilized . Herein we review our experience with renal biopsy immediately prior to laparoscopic RFA . METHODS AND MATERIAL S A prospect ively collected data base containing all patients who underwent laparoscopic RFA by three different surgeons at two different institutions was review ed . Renal biopsies were performed in each patient during transperitoneal laparoscopy after mobilization of the kidney and prior to RFA . The biopsy needle was passed percutaneously via a sheath through the abdominal wall . Multiple core biopsies ( 3 - 5 ) were taken under visual and ultrasonic guidance . All were su bmi tted for permanent pathologic sectioning . RESULTS 138 patients underwent renal biopsy prior to RFA . Mean tumor size was 3.0 cm ( range 1.0 - 6.9 ) . The mean age was 72 years ( range 39 - 90 ) . There were 42 females and 96 males .  Mean blood loss was 28 ml ( 0 - 400 ml ) . Only 5 patients lost more than 50 ml , and in each case the bleeding was associated with complicated renal mobilization and dissection prior to biopsy . Final pathology revealed renal cell carcinoma in 95 , oncocytic neoplasm in 26 , and angiomyolipoma in 9.8 patients were considered to have nondiagnostic biopsies . In this group , final pathology revealed benign cysts in 3 , inconclusive specimens in 3 , fibrosis in 1 , and normal tissue in 1 . Hence , a clear diagnosis was possible in 130 of 138 patients , which is 94.2 % . RCC was diagnosed in 68.8 % of the patients , and in 73.1 % of the conclusive biopsies . Eight patients had perioperative complications , including low- grade fevers ( 2 ) perirenal/retroperitonal hematoma ( 2 ) , pleural tear/pneumothorax ( 2 ) , CHF exacerbation , and wound infection . CONCLUSIONS In our multicenter experience , renal biopsy of 138 renal lesions at the time of laparoscopic RFA had a diagnostic yield of 94.2 % . RCC was diagnosed in 68.8 % of the patients , and in 73.1 % of the conclusive biopsies BACKGROUND Besides clinical tumour size , other anatomical aspects of the renal tumour are routinely considered when evaluating the feasibility of elective nephron-sparing surgery ( NSS ) . OBJECTIVE To propose an original , st and ardised classification of renal tumours suitable for NSS based on their anatomical features and size and to evaluate the ability of this classification to predict the risk of overall complications result ing from the surgery . DESIGN , SETTING , AND PARTICIPANTS We enrolled prospect ively 164 consecutive patients who underwent NSS for renal tumours at a tertiary academic referral centre from January 2007 to December 2008 . INTERVENTION Open partial nephrectomy without vessel clamping . MEASUREMENTS All tumours were classified by integrating size with the following anatomical features : anterior or posterior face , longitudinal , and rim tumour location ; tumour relationships with renal sinus or urinary collecting system ; and percentage of tumour deepening into the kidney . We generated an algorithm evaluating each anatomical parameter and tumour size ( the preoperative aspects and dimensions used for an anatomical [ PADUA ] score ) to predict the risk of complications . RESULTS AND LIMITATIONS Overall rates of complication were significantly correlated to all the evaluated anatomical aspects , excluding clinical size and anterior or posterior location of the tumour . By multivariate analysis , PADUA scores were independent predictors of the occurrence of any grade complications ( hazard ratio [ HR ] for score 8 - 9 vs 6 - 7 : 14.535 ; HR for score ≥10 vs 6 - 7 : 30.641 ) . Potential limitations were the limited number of patients with T1b tumours included in the study and the lack of laparoscopically treated patients . Further external validation of the PADUA score is needed . CONCLUSIONS The PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS . The use of an appropriate score can help clinicians stratify patients suitable for NSS into subgroups with different complication risks and can help research ers evaluate the real comparability among patients undergoing NSS with different surgical approaches PURPOSE The majority of cytogenetic studies in renal cell carcinoma ( RCC ) have been impaired by small sample size , retrospective character , and lack of a survival end point . We prospect ively studied the prognostic impact of cytogenetic abnormalities on a larger cohort of patients having up to 108 months of follow-up . PATIENTS AND METHODS Tumors of 282 patients who underwent nephrectomy for clear cell RCC were cytogenetically analyzed . Results were correlated with pathological factors and disease-specific survival . RESULTS The most frequently observed cytogenetic abnormalities were loss of 3p ( 60 % ) , gain of 5q ( 33 % ) , loss of 14q ( 28 % ) , trisomy 7 ( 26 % ) , loss of 8p ( 20 % ) , loss of 6q ( 17 % ) , loss of 9p ( 16 % ) , loss of 4p ( 13 % ) , and loss of chromosome Y in men ( 55 % ) . Tumors with loss of 3p presented at lower TNM stages . Loss of 4p , 9p , and 14q were all associated with higher TNM stages , higher grade , and greater tumor size . A deletion of 3p was associated with better prognosis ( P = .03 ) , while loss of 4p ( P < .001 ) , loss of 9p ( P < .01 ) , and loss of 14q ( P < .01 ) were each associated with worse prognosis . Loss of the Y chromosome led to improved progression-free survival in metastatic patients ( P = .02 ) . In multivariate analysis , loss of 9p was retained as an independent prognostic factor . CONCLUSION This cytogenetic study serves as a proof of principal that genetic information , such as loss of chromosome 9 , can be obtained from widely available technology , and can provide additional prognostic information to st and ard clinicopathologic variables PURPOSE We review our single center experience in the management of renal angiomyolipoma ( AML ) in patients who were treated with active surveillance ( AS ) or invasive treatment protocol s.  PATIENTS AND METHODS A prospect ively evaluated data base was review ed , and we identified 91 patients with the diagnosis of renal AML who presented between June 1985 and February 2009 . Patient characteristics , clinical presentation , treatment modalities , and patient outcomes were evaluated . Patients on AS were analyzed for successful completion of the surveillance protocol considering age , symptomatic presentation , and tumor size as potential predictors of invasive treatment . RESULTS A total of 91 patients with AMLs were identified . The mean patient age was 57 years . Seventy-three ( 83.9 % ) patients presented incidentally , and 14 ( 16 % ) patients were symptomatic at presentation . Forty-five patients were treated with AS , 4 underwent embolization , and 38 patients had extirpative surgery . After a median follow-up of 54.8 months ( range 0.2 - 211.7 mos ) , there was a mean growth rate of 0.088 cm/year in the group who were treated with AS . AS failed in three patients . Two patients had retroperitoneal bleeding during the observation period , and one patient manifested an expeditious growth rate of 0.7 cm/year and underwent a radical nephrectomy . CONCLUSIONS AML is a renal tumor that usually exhibits a benign course . Surgical removal and embolization are the st and ard invasive treatment modalities . AS for AMLs is associated with a slow and consistent growth rate ( 0.088 cm/year ) , typically has minimal morbidity , and is a reasonable option in selected patients . Symptomatic presentation and size ( > 3 cm ) are not predictive for necessitating an invasive procedure BACKGROUND Most early stage kidney cancers are renal cell carcinomas ( RCCs ) , and most are diagnosed incidentally by imaging as small renal masses ( SRMs ) . Indirect evidence suggests that most small RCCs grow slowly and rarely metastasize . OBJECTIVE To determine the progression and growth rates for newly diagnosed SRMs stratified by needle core biopsy pathology . DESIGN , SETTING , AND PARTICIPANTS A multicenter prospect i ve phase 2 clinical trial of active surveillance of 209 SRMs in 178 elderly and /or infirm patients was conducted from 2004 until 2009 with treatment delayed until progression . INTERVENTION Patients underwent serial imaging and needle core biopsies . MEASUREMENTS We measured rates of change in tumor diameter ( growth measured by imaging ) and progression to ≥ 4 cm , doubling of tumor volume , or metastasis with histology on biopsy . RESULTS AND LIMITATIONS Local progression occurred in 25 patients ( 12 % ) , plus 2 progressed with metastases ( 1.1 % ) . Of the 178 subjects with 209 SRMs , 127 with 151 SRMs had>12 mo of follow-up with two or more images , with a mean follow-up of 28 mo . Their tumor diameters increased by an average of 0.13 cm/yr . Needle core biopsy in 101 SRMs demonstrated that the presence of RCC did not significantly change growth rate . Limitations included no central review of imaging and pathology and a short follow-up . CONCLUSIONS This is the first SRM active surveillance study to correlate growth with histology prospect ively . In the first 2 yr , the rate of local progression to higher stage is low , and metastases are rare . SRMs appear to grow very slowly , even if biopsy proven to be RCC . Many patients with SRMs can therefore be initially managed conservatively with serial imaging , avoiding the morbidity of surgical or ablative treatment Purpose Exploratory subgroup analyses from the phase 3 global advanced renal cell carcinoma ( ARCC ) trial were conducted to assess the influence of tumor histology on outcome of patients treated with temsirolimus ( Torisel ™ ) or interferon-α ( IFN ) .  Patients and methods Patients with ARCC including clear cell and other types such as papillary and chromophobe histologies received either IFN ( 3 million units [ MU ] subcutaneously three times weekly , escalating to 18 MU ) or temsirolimus ( 25 mg intravenously weekly ) . Results Approximately 80 % of patients had clear cell and 20 % of patients had other histologies , the majority of which were papillary . Patients with clear cell and other RCC histologies , treated with temsirolimus , demonstrated comparable median overall and progression-free survival . In contrast , patients with other RCC histologies , treated with IFN , demonstrated shorter median overall and progression-free survival than patients with clear cell RCC . Hazard ratios for death for treatment with temsirolimus versus IFN were less than 1 for patients regardless of tumor histology . For patients treated with temsirolimus , 59 % with clear cell and 68 % with other RCC histologies experienced tumor reductions . For patients treated with IFN , 35 % with clear cell and 14 % with other RCC histologies had tumor reductions . However , temsirolimus did not appear to improve the objective response rate compared to IFN . Temsirolimus result ed in a superior clinical benefit rate compared with IFN , regardless of tumor histology . Conclusion Temsirolimus appears to be efficacious in patients with clear cell and non-clear cell histologies and can , therefore , be used for the treatment of all types of RCC PURPOSE We present 5 to 11-year ( median 8) oncological outcomes after laparoscopic renal cryoablation . MATERIAL S AND METHODS Between September 1997 and October 2008 we performed renal cryoablation in 340 patients , of whom 80 treated laparoscopically by a single surgeon before October 2003 had a minimum 5-year followup . Followup involved magnetic resonance imaging on postoperative day 1 , at 3 , 6 and 12 months , and annually thereafter . Cryolesion biopsy was performed at 6 months . All data were prospect ively accrued . RESULTS In the 80 patients with minimum 5-year followup mean age was 66 years , mean tumor size was 2.3 cm ( range 0.9 to 5.0 ) , median American Society of Anesthesiologists score was 3 and mean body mass index was 28 kg/m(2 ) . Five patients had local recurrence , 2 had locoregional recurrence with metastasis and 4 had distant metastasis without locoregional recurrence . Six patients died of cancer . In the 55 patients with biopsy proven renal cell cancer at a median followup of 93 months ( range 60 to 132 ) 5-year overall , disease specific and disease-free survival rates were 84 % , 92 % and 81 % , and 10-year rates were 51 % , 83 % and 78 % , respectively . On multivariate analysis previous radical 
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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 .