Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma

Systematic review of the literature

Research output: Contribution to journalArticle

Abstract

Purpose Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. Materials and Methods MEDLINE®, Embase® and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Results A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (∼80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%). Conclusions Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility.

Original languageEnglish (US)
Pages (from-to)1340-1347
Number of pages8
JournalJournal of Urology
Volume195
Issue number5
DOIs
StatePublished - May 1 2016

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Renal Cell Carcinoma
Kidney
Biopsy
Surgical Pathology
Health Services Research
Hematuria
Pneumothorax
MEDLINE
Hematoma
Databases
Hemorrhage
Pain
Research

Keywords

  • biopsy
  • carcinoma, renal cell
  • complications
  • data accuracy
  • diagnosis

ASJC Scopus subject areas

  • Urology

Cite this

@article{1fef6eade0dc4e1c84574332c96935cd,
title = "Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: Systematic review of the literature",
abstract = "Purpose Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. Materials and Methods MEDLINE{\circledR}, Embase{\circledR} and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Results A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1{\%} with 90.4{\%} of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80{\%} of patients. The false-positive rate was low (4.0{\%}), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16{\%}) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5{\%}, CI 96.5-98.5) and specific (96.2{\%}, CI 90.7-100) when a diagnostic result was obtained, but most patients (∼80{\%}) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7{\%} with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3{\%}, CI 52.4-74.2). Direct complications included hematoma (4.9{\%}), clinically significant pain (1.2{\%}), gross hematuria (1.0{\%}), pneumothorax (0.6{\%}) and hemorrhage (0.4{\%}). Conclusions Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility.",
keywords = "biopsy, carcinoma, renal cell, complications, data accuracy, diagnosis",
author = "Patel, {Hiten D.} and Michael Johnson and Pierorazio, {Phillip Martin} and Sozio, {Stephen M} and Ritu Sharma and Emmanuel Iyoha and Bass, {Eric B} and Allaf, {Mohamad E}",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.juro.2015.11.029",
language = "English (US)",
volume = "195",
pages = "1340--1347",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
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TY - JOUR

T1 - Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma

T2 - Systematic review of the literature

AU - Patel, Hiten D.

AU - Johnson, Michael

AU - Pierorazio, Phillip Martin

AU - Sozio, Stephen M

AU - Sharma, Ritu

AU - Iyoha, Emmanuel

AU - Bass, Eric B

AU - Allaf, Mohamad E

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Purpose Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. Materials and Methods MEDLINE®, Embase® and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Results A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (∼80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%). Conclusions Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility.

AB - Purpose Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. Materials and Methods MEDLINE®, Embase® and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Results A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5-98.5) and specific (96.2%, CI 90.7-100) when a diagnostic result was obtained, but most patients (∼80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4-74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%). Conclusions Diagnostic accuracy was generally high for biopsy of localized renal masses with a low complication rate, but the nondiagnostic rate and negative predictive value were concerning. Renal mass sampling should be used judiciously as further research will determine its true clinical utility.

KW - biopsy

KW - carcinoma, renal cell

KW - complications

KW - data accuracy

KW - diagnosis

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