Advancements in imaging modalities have increased the frequency of renal mass discovery. Imaging has typically been considered sufficient to guide management for a large proportion of these tumours, but renal mass biopsies (RMBs) have an increasing role in determining malignancy and can be a valuable tool for preventing unnecessary surgery in patients with benign tumours. A structured approach should be used to help to navigate the expanding repertoire of renal tumours, many of which are molecularly defined. In terms of tumour subtyping, the pathologist’s strategy should focus on stratifying patients into clinically different prognostic groups according to our current knowledge of tumour behaviour, including benign, low-grade or indolent, intermediate malignant or highly aggressive. Crucial pathological features and morphological mimicry of tumours can alter the tumour’s prognostic group. Thus, pathologists and urologists can use RMB to select patients with tumours at a reduced risk of progression, which can be safely managed with active surveillance within a tailored imaging schedule, versus tumours for which ablation or surgical intervention is indicated. RMB is also crucial in the oncological setting to distinguish between different high-grade tumours and guide tailored management strategies.

影像学检查方式的进步增加了肾脏肿块发现的频率。通常认为影像学检查足以指导大部分肿瘤的治疗，但肾脏肿块活检 （RMB） 在确定恶性肿瘤方面的作用越来越大，可以成为防止良性肿瘤患者进行不必要手术的宝贵工具。应使用结构化方法来帮助导航不断扩大的肾肿瘤库，其中许多是分子定义的。在肿瘤亚型方面，病理学家的策略应侧重于根据我们目前对肿瘤行为的了解，将患者分为临床上不同的预后组，包括良性、低度或惰性、中度恶性或高度侵袭性。肿瘤的关键病理特征和形态模拟可以改变肿瘤的预后组。因此，病理学家和泌尿科医生可以使用 RMB 来选择进展风险较低的肿瘤患者，与需要消融或手术干预的肿瘤相比，可以在量身定制的影像学计划内通过主动监测进行安全管理。RMB 在肿瘤学环境中也至关重要，可以区分不同的高级别肿瘤并指导量身定制的管理策略。