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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

References

    1. Volpe A, Terrone C, Scarpa RM. The current role of percutaneous needle biopsies of renal tumours. Arch Ital Urol Androl 2009; 81: 107–12. - PubMed
    1. Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. . Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol 2016; 69: 660–73. doi: 10.1016/j.eururo.2015.07.072 - DOI - PubMed
    1. He Q, Wang H, Kenyon J, Liu G, Yang L, Tian J, et al. . Accuracy of Percutaneous Core Biopsy in the Diagnosis of Small Renal Masses (≤ 4.0 cm): A Meta-analysis. Int Braz J Urol 2015; 41: 15–25. - PMC - PubMed
    1. Abel EJ, Culp SH, Matin SF, Tamboli P, Wallace MJ, Jonasch E, et al. . Percutaneous biopsy of primary tumor in metastatic renal cell carcinoma to predict high risk pathological features: comparison with nephrectomy assessment. J Urol 2010; 184: 1877–81. doi: 10.1016/j.juro.2010.06.105 - DOI - PMC - PubMed
    1. Blumenfeld AJ, Guru K, Fuchs GJ, Kim HL. Percutaneous biopsy of renal cell carcinoma underestimates nuclear grade. Urology 2010; 76: 610–3. doi: 10.1016/j.urology.2009.09.095 - DOI - PubMed

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