**3. Contemporary indications and contraindications for biopsy**

The EAU guidelines recommend RTBs to be performed for AS on selected patients with SRMs, prior to ablative treatments and patients suffering from renal metastatic disease before embarking on systemic treatment.

The American Urological Association (**AUA**) guidelines stipulate that biopsies should be considered when a renal mass is suspected to be metastatic, hematological, inflammatory or infectious. RTBs are also expected to be performed before ablative procedures.

Historically, absolute contraindications to RTBs include uncontrolled severe hypertension, inability to cooperate with biopsy, solitary kidney and uncontrollable bleeding diathesis [5]. Relative contraindications may include a lack of a safe pathway to the lesion and pregnancy where imaging guidance involves ionizing radiation.
