Diagnostic accuracy and safety of renal tumour biopsy in patients with small renal masses and its impact on treatment decisions
DOI:
https://doi.org/10.2340/sju.v59.40844Keywords:
Renal tumour biopsy, small renal masses, renal tumour biopsy, percutaneous renal biopsy, renal cell carcinoma, oncocytomaAbstract
Objective: To assess the safety and diagnostic accuracy of renal tumour biopsy (RTB) in patients with small renal masses (SRM) and to assess if RTB prevents overtreatment in patients with benign SRM.
Material and methods: In a retrospective, single-centre study from Västmanland, Sweden, 195 adult patients (69 women and 126 men) with SRM ≤ 4 cm who had undergone RTB during 2010–2023 were included. The median age was 70 years (range 23–89). The sensitivity, specificity and predictive values of RTB were calculated using the final diagnosis as the reference standard. Treatment outcomes were recorded for a median 42-month follow-up. Complications following the biopsies were assessed according to the Clavien–Dindo system.
Results: The overall sensitivity of RTB was 95% (95% confidence interval [CI] 90% – 98%) and specificity was 100% (95% CI 95% – 100%). The positive predictive value was 100% and negative predictive value was 92%. The rate of agreement between RTB and the final diagnosis measured using kappa statistics was 0.92. Of the 195 patients, 62 underwent surgery and 48 were treated with ablation. The concordance rate between the RTB histology and final histology after surgery was 89%. Treatment was withheld in 67 of 195 patients with a benign or inconclusive RTB. No patients developed renal cell carcinoma or metastasis during follow-up. Complications occurred in two patients that were classified with Clavien–Dindo grades I and IV.
Conclusions: Percutaneous renal tumour biopsy appears to be a safe diagnostic method that provides accurate histopathological information about small renal masses and reduces overtreatment of benign SRM.
Downloads
References
Kjellman A, Lindblad P, Lundstam S et al. Predictive characteristics for disease recurrence and overall survival in non-metastatic clinical T1 renal cell carcinoma – results from the National Swedish Kidney Cancer Quality Register Group. Scand J Urol. 2023;57(1–6):67–74. https://doi.org/10.1080/21681805.2022.2154383 DOI: https://doi.org/10.1080/21681805.2022.2154383
Thorstenson A, Harmenberg U, Lindblad P, et al. Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma. Scand J Urol. 2016;50(1):2–8. https://doi.org/10.3109/21681805.2015.1059882 DOI: https://doi.org/10.3109/21681805.2015.1059882
Key statistics about kidney cancer. Available from: https://www.cancer.org/cancer/kidney-cancer/about/key-statistics.html [cited 13 October 2022].
Vasudevan A, Davies RJ, Shannon BA, et al. Incidental renal tumours: the frequency of benign lesions and the role of preoperative core biopsy. BJU Int. 2006;97(5):946–9. https://doi.org/10.1111/j.1464-410X.2006.06126.x DOI: https://doi.org/10.1111/j.1464-410X.2006.06126.x
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. Eur Urol. 2022;82(4):399–410. https://doi.org/10.1016/j.eururo.2022.03.006 DOI: https://doi.org/10.1016/j.eururo.2022.03.006
Johnson DC, Vukina J, Smith AB, et al. Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol. 2015;193(1):30–5. https://doi.org/10.1016/j.juro.2014.07.102 DOI: https://doi.org/10.1016/j.juro.2014.07.102
Londoño DC, Wuerstle MC, Thomas AA, et al. Accuracy and implications of percutaneous renal biopsy in the management of renal masses. Perm J. 2013;17(3):4–7. https://doi.org/10.7812/TPP/12-110 DOI: https://doi.org/10.7812/TPP/12-110
He Q, Wang H, Kenyon 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. https://doi.org/10.1590/S1677-5538.IBJU.2015.01.04 DOI: https://doi.org/10.1590/S1677-5538.IBJU.2015.01.04
Wang R, Wolf JS, Wood DP, et al. Accuracy of percutaneous core biopsy in management of small renal masses. Urology. 2009;73(3):586–90. https://doi.org/10.1016/j.urology.2008.08.519 DOI: https://doi.org/10.1016/j.urology.2008.08.519
Marconi L, Dabestani S, Lam TB, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016;69(4):660–73. https://doi.org/10.1016/j.eururo.2015.07.072
Richard PO, Jewett MAS, Bhatt JR, et al. Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol. 2015;68(6):1007–13. https://doi.org/10.1016/j.eururo.2015.04.004 DOI: https://doi.org/10.1016/j.eururo.2015.04.004
Moch H, Amin MB, Berney DM, et al. The 2022 World Health Organization classification of tumours of the urinary system and male genital organs – part A: renal, penile, and testicular tumours. Eur Urol. 2022;82(5):458–68. https://doi.org/10.1016/j.eururo.2022.06.016 DOI: https://doi.org/10.1016/j.eururo.2022.06.016
Schoonjans F. MedCalc’s diagnostic test evaluation calculator. MedCalc. Available from: https://www.medcalc.org/calc/diagnostic_test.php [cited 2 December 2023].
Tolouee SA, Madsen M, Berg KD, et al. Renal tumor biopsies are associated with a low complication rate. Scand J Urol. 2018;52:407–10. https://doi.org/10.1080/21681805.2018.1524397 DOI: https://doi.org/10.1080/21681805.2018.1524397
Laguna MP, Kümmerlin I, Rioja J, et al. Biopsy of a renal mass: where are we now? Curr Opin Urol. 2009;19(5):447–53. https://doi.org/10.1097/MOU.0b013e32832f0d5a DOI: https://doi.org/10.1097/MOU.0b013e32832f0d5a
Couture F, Finelli T, Breau RH, et al. The increasing use of renal tumor biopsy amongst Canadian urologists: when is biopsy most utilized? Urol Oncol. 2021;39(8):499.e15–22. https://doi.org/10.1016/j.urolonc.2021.05.026 DOI: https://doi.org/10.1016/j.urolonc.2021.05.026
Lim A, O’Neil B, Heilbrun ME, et al. The contemporary role of renal mass biopsy in the management of small renal tumors. Front Oncol. 2012;2:106. https://doi.org/10.3389/fonc.2012.00106 DOI: https://doi.org/10.3389/fonc.2012.00106
Frank I, Blute ML, Cheville JC, et al. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170(6 Pt 1):2217–20. https://doi.org/10.1097/01.ju.0000095475.12515.5e DOI: https://doi.org/10.1097/01.ju.0000095475.12515.5e
Jeong CW, Han JH, Byun SS, et al. Rate of benign histology after resection of suspected renal cell carcinoma: multicenter comparison between Korea and the United States. BMC Cancer. 2024;24:216. https://doi.org/10.1186/s12885-024-11941-3 DOI: https://doi.org/10.1186/s12885-024-11941-3
Richard PO, Violette PD, Bhindi B, et al. Canadian Urological Association guideline: management of small renal masses. Can Urol Assoc J. 2022;16(2):E61–75. https://doi.org/10.5489/cuaj.7763 DOI: https://doi.org/10.5489/cuaj.7763
Lavallée LT, McAlpine K, Kapoor A, et al. Kidney Cancer Research Network of Canada (KCRNC) consensus statement on the role of renal mass biopsy in the management of kidney cancer. Can Urol Assoc J. 2019;13(12):377–83. https://doi.org/10.5489/cuaj.6176 DOI: https://doi.org/10.5489/cuaj.6176
Born KB, Levinson W. Choosing Wisely campaigns globally: a shared approach to tackling the problem of overuse in healthcare. J Gen Fam Med. 2018;20(1):9–12. https://doi.org/10.1002/jgf2.225 DOI: https://doi.org/10.1002/jgf2.225
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bassam Mazin Hashima, Abbas Chabok, Börje Ljungberg, Erland Östberg, Farhood Alamdari
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
