Surgical histopathology for suspected oncocytoma on renal mass biopsy

a systematic review and meta-analysis

Research output: Contribution to journalReview article

Abstract

To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.

Original languageEnglish (US)
Pages (from-to)661-666
Number of pages6
JournalBJU International
Volume119
Issue number5
DOIs
StatePublished - May 1 2017

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Meta-Analysis
Oxyphilic Adenoma
Kidney
Biopsy
Surgical Pathology
Kidney Neoplasms
Renal oncocytoma
Renal Cell Carcinoma
MEDLINE
Uncertainty
Neoplasms
Databases
Confidence Intervals
Physicians

Keywords

  • biopsy
  • diagnostic accuracy
  • oncocytoma
  • renal cell carcinoma
  • renal mass

ASJC Scopus subject areas

  • Urology

Cite this

Surgical histopathology for suspected oncocytoma on renal mass biopsy : a systematic review and meta-analysis. / Patel, Hiten D.; Druskin, Sasha C.; Rowe, Steven; Pierorazio, Phillip Martin; Gorin, Michael; Allaf, Mohamad E.

In: BJU International, Vol. 119, No. 5, 01.05.2017, p. 661-666.

Research output: Contribution to journalReview article

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title = "Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta-analysis",
abstract = "To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4{\%}) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6{\%}), chromophobe renal cell carcinoma (RCC; 12.5{\%}), other RCC (12.5{\%}), hybrid oncocytic/chromophobe tumour (6.3{\%}), and other benign lesions (4.2{\%}). PPV of oncocytoma on RMB was 67{\%} (95{\%} confidence interval 34–94{\%}) with significant heterogeneity between studies (I2 = 71.8{\%}, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.",
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T2 - a systematic review and meta-analysis

AU - Patel, Hiten D.

AU - Druskin, Sasha C.

AU - Rowe, Steven

AU - Pierorazio, Phillip Martin

AU - Gorin, Michael

AU - Allaf, Mohamad E

PY - 2017/5/1

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N2 - To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.

AB - To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy (RMB) confirmed on surgical pathology, a systematic review of MEDLINE, Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [PPV]) was evaluated for patients undergoing surgery by performing a meta-analysis. In all, 10 RMB series, including institutional data, were included in the meta-analysis with 205 RMBs identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma (RCC; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies (I2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.

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KW - diagnostic accuracy

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