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. 2018 Oct;91(1090):20170761.
doi: 10.1259/bjr.20170761. Epub 2018 Aug 31.

Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence

Catherine Paterson  1 , Joseph Ghaemi  2 , Abduelmenem Alashkham  3 , Chandra Shekhar Biyani  4 , Bernadette Coles  5 , Lee Baker  6 , Magdalena Szewczyk-Bieda  2 , Ghulam Nabi  2
Affiliations

Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence

Catherine Paterson et al. Br J Radiol. 2018 Oct.

Abstract

Objective:: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach.

Methods:: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity.

Results:: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased.

Conclusion:: RTB in SRMs (<4 cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3 × 2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards.

Advances in knowledge:: A comprehensive synthesis of literature on image-guided biopsies in SRMs using a different methodology and study design.

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Figures

Figure 1.
Figure 1.
Explanation of 3 × 2 table analysis for the non-diagnostic results.
Figure 2.
Figure 2.
Flow of the diagnostic review.
Figure 3.
Figure 3.
Diagnostic accuracy of image guided biopsies in small renal masses (<4 cm). CI, confidence interval.
Figure 4.
Figure 4.
Receiver operating characteristic (ROC) analysis of the results.
See this image and copyright information in PMC

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