Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy.
BACKGROUND
The role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety.


OBJECTIVE
We performed a systematic review and meta-analysis to determine the safety and accuracy of percutaneous RTB for the diagnosis of malignancy, histologic tumour subtype, and grade.


METHODS
Medline, Embase, and Cochrane Library were searched for studies providing data on diagnostic accuracy and complications of percutaneous core biopsy (CB) or fine-needle aspiration (FNA) of renal tumours. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for diagnosis of malignancy. The Cohen kappa coefficient (κ) was estimated for the analysis of histotype/grade concordance between diagnosis on RTB and surgical specimen. Risk of bias assessment was performed (QUADAS-2).


RESULTS
A total of 57 studies recruiting 5228 patients were included. The overall median diagnostic rate of RTB was 92%. The sensitivity and specificity of diagnostic CBs and FNAs were 99.1% and 99.7%, and 93.2% and 89.8%, respectively. A good (κ = 0.683) and a fair (κ = 0.34) agreement were observed between histologic subtype and Fuhrman grade on RTB and surgical specimen, respectively. A very low rate of Clavien ≥ 2 complications was reported. Study limitations included selection and differential-verification bias.


CONCLUSIONS
RTB is safe and has a high diagnostic yield in experienced centres. Both CB and FNA have good accuracy for the diagnosis of malignancy and histologic subtype, with better performance for CB. The accuracy for Fuhrman grade is fair. Overall, the quality of the evidence was moderate. Prospective cohort studies recruiting consecutive patients and using homogeneous reference standards are required.


RESULTS
We systematically reviewed the literature to assess the safety and diagnostic performance of renal tumour biopsy (RTB). The results suggest that RTB has good accuracy in diagnosing renal cancer and its subtypes, and it appears to be safe. However, the quality of evidence was moderate, and better quality studies are required to provide a more definitive answer.
Department of Urology, Coimbra University Hospital, Coimbra, Portugal.
Lorenzo
L
Marconi
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Saeed
S
Dabestani
Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
Thomas B
TB
Lam
Department of Urology, Sunderby Hospital, Sunderby, Sweden.
Fabian
F
Hofmann
Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
Fiona
F
Stewart
Health Services Research Unit, University of Aberdeen, UK.
John
J
Norrie
Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Axel
A
Bex
Department of Urology, University of Rennes, Rennes, France.
Karim
K
Bensalah
Division of Urology, University of Texas Medical School at Houston, Houston, TX, USA.
Steven E
SE
Canfield
Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic.
Milan
M
Hora
Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany.
Markus A
MA
Kuczyk
Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Axel S
AS
Merseburger
Department of Urology, Radboud University, Nijmegen, The Netherlands.
Peter F A
PFA
Mulders
Barts Cancer Institute, Queen Mary University of London, St. Bartholomew's Hospital, London, UK.
Thomas
T
Powles
Department of Urology, Ludwig-Maximilians University, Munich, Germany.
Michael
M
Staehler
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
Borje
B
Ljungberg
Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy. Electronic address: alessandro.volpe@med.uniupo.it.
Alessandro
A
Volpe
D044963:Biopsy, Fine-Needle; D062005:Biopsy, Large-Core Needle; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D060787:Neoplasm Grading; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
Accuracy; Diagnosis; Fine-needle aspiration; Meta-analysis; Needle core biopsy; Renal cell carcinoma; Renal mass