📃 Paper Title: Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy
🧍 Author: Marconi
🕒 Year: 2016
📚 Journal: European Urology
🌎 Country: Portugal
ㅤContext to the study:
What do you know about the diagnostic accuracy of renal tumour biopsy?
ㅤ✅ Take-home message of study:
In a large systematic review and meta-analysis a high diagnostic yield of renal tumour biopsy was confirmed.
Biopsy was diagnostic in majority.
The sensitivity and specificity of core biopsy (CB) for diagnosis of malignancy was excellent (99.1% and 99.7% respectively).
CB showed good concordance with histological subtype and fair concordance with Fuhrman grade.
Fine needle aspiration was inferior but still performed well.
The median complication rate was 8.1%; predominantly Clavien Grade 1-2.
One case of tumour seeding was identified in the included studies; this was of a transitional cell carcinoma.
ㅤ Systematic review and meta-analysis
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Study participants:
57 studies (5228 patients)
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Key study outcomes:
Malignant histology reference standard was surgical specimen
Benign histology reference standard considered acceptable was 12 month follow-up with no progression or symptoms
The overall median diagnostic rate was 92% (non-diagnostic core biopsies reported 0 - 22.6% and FNA 0-36%)
Core biopsy sensitivity and specificity: 99.1% and 99.7%
FNA sensitivity and specificity: 93.2% and 89.8%
Complications median 8.1% (22 studies) (generally pain, self-limiting haematoma, haematuria); Clavien-Dindo >2 in 3 patients (endovascular embolization, septic shock in pyelonephritic kidney)
Haematoma median 5% and transfusion median 0.7%
One case of tumour seeding (TCC)
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Study Limitations:
Included studies of moderate quality evidence, and possible selection bias in each and different reference standards (differential-verification bias).
Most studies were limited by small sample sizes.
Relatively short follow-up - potential false negatives not identified.
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