Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy

Lorenzo Marconi, Saeed Dabestani, Thomas B. Lam, Fabian Hofmann, Fiona Stewart, John Norrie, Axel Bex, Karim Bensalah, Steven E. Canfield, Milan Hora, Markus A. Kuczyk, Axel S. Merseburger, Peter F. A. Mulders, Thomas Powles, Michael Staehler, Borje Ljungberg, Alessandro Volpe

Research output: Contribution to journalArticle

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Abstract

Context
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.

Evidence acquisition
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).

Evidence synthesis
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.

Patient summary
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.
Original languageEnglish
Pages (from-to)660-673
Number of pages14
JournalEuropean Urology
Volume69
Issue number4
Early online date29 Aug 2015
DOIs
Publication statusPublished - Apr 2016

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Meta-Analysis
Kidney
Biopsy
Neoplasms
Fine Needle Biopsy
Safety
Sensitivity and Specificity
Kidney Neoplasms
Libraries
Uncertainty
Cohort Studies
Prospective Studies

Keywords

  • accuracy
  • diagnosis
  • fine needle aspiration
  • meta-analysis
  • needle core biopsy
  • renal mass
  • renal cell carcinoma

Cite this

Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. / Marconi, Lorenzo; Dabestani, Saeed; Lam, Thomas B.; Hofmann, Fabian ; Stewart, Fiona; Norrie, John; Bex, Axel; Bensalah, Karim ; Canfield, Steven E.; Hora, Milan ; Kuczyk, Markus A. ; Merseburger, Axel S. ; Mulders, Peter F. A.; Powles, Thomas; Staehler, Michael; Ljungberg, Borje ; Volpe, Alessandro .

In: European Urology, Vol. 69, No. 4, 04.2016, p. 660-673.

Research output: Contribution to journalArticle

Marconi, L, Dabestani, S, Lam, TB, Hofmann, F, Stewart, F, Norrie, J, Bex, A, Bensalah, K, Canfield, SE, Hora, M, Kuczyk, MA, Merseburger, AS, Mulders, PFA, Powles, T, Staehler, M, Ljungberg, B & Volpe, A 2016, 'Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy', European Urology, vol. 69, no. 4, pp. 660-673. https://doi.org/10.1016/j.eururo.2015.07.072
Marconi, Lorenzo ; Dabestani, Saeed ; Lam, Thomas B. ; Hofmann, Fabian ; Stewart, Fiona ; Norrie, John ; Bex, Axel ; Bensalah, Karim ; Canfield, Steven E. ; Hora, Milan ; Kuczyk, Markus A. ; Merseburger, Axel S. ; Mulders, Peter F. A. ; Powles, Thomas ; Staehler, Michael ; Ljungberg, Borje ; Volpe, Alessandro . / Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. In: European Urology. 2016 ; Vol. 69, No. 4. pp. 660-673.
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title = "Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy",
abstract = "ContextThe role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety.ObjectiveWe 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.Evidence acquisitionMedline, 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).Evidence synthesisA 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.ConclusionsRTB 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.Patient summaryWe 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.",
keywords = "accuracy, diagnosis, fine needle aspiration, meta-analysis, needle core biopsy, renal mass, renal cell carcinoma",
author = "Lorenzo Marconi and Saeed Dabestani and Lam, {Thomas B.} and Fabian Hofmann and Fiona Stewart and John Norrie and Axel Bex and Karim Bensalah and Canfield, {Steven E.} and Milan Hora and Kuczyk, {Markus A.} and Merseburger, {Axel S.} and Mulders, {Peter F. A.} and Thomas Powles and Michael Staehler and Borje Ljungberg and Alessandro Volpe",
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TY - JOUR

T1 - Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy

AU - Marconi, Lorenzo

AU - Dabestani, Saeed

AU - Lam, Thomas B.

AU - Hofmann, Fabian

AU - Stewart, Fiona

AU - Norrie, John

AU - Bex, Axel

AU - Bensalah, Karim

AU - Canfield, Steven E.

AU - Hora, Milan

AU - Kuczyk, Markus A.

AU - Merseburger, Axel S.

AU - Mulders, Peter F. A.

AU - Powles, Thomas

AU - Staehler, Michael

AU - Ljungberg, Borje

AU - Volpe, Alessandro

N1 - Funding/Support and role of the sponsor: None.

PY - 2016/4

Y1 - 2016/4

N2 - ContextThe role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety.ObjectiveWe 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.Evidence acquisitionMedline, 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).Evidence synthesisA 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.ConclusionsRTB 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.Patient summaryWe 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.

AB - ContextThe role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety.ObjectiveWe 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.Evidence acquisitionMedline, 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).Evidence synthesisA 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.ConclusionsRTB 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.Patient summaryWe 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.

KW - accuracy

KW - diagnosis

KW - fine needle aspiration

KW - meta-analysis

KW - needle core biopsy

KW - renal mass

KW - renal cell carcinoma

U2 - 10.1016/j.eururo.2015.07.072

DO - 10.1016/j.eururo.2015.07.072

M3 - Article

VL - 69

SP - 660

EP - 673

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 4

ER -