Marconi Lorenzo, Dabestani Saeed, Lam Thomas B, Hofmann Fabian, Stewart Fiona, Norrie John, Bex Axel, Bensalah Karim, Canfield Steven E, Hora Milan, Kuczyk Markus A, Merseburger Axel S, Mulders Peter F A, Powles Thomas, Staehler Michael, Ljungberg Borje, Volpe Alessandro
Department of Urology, Coimbra University Hospital, Coimbra, Portugal.
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Eur Urol. 2016 Apr;69(4):660-673. doi: 10.1016/j.eururo.2015.07.072. Epub 2015 Aug 29.
The role of percutaneous renal tumour biopsy (RTB) remains controversial due to uncertainties regarding its diagnostic accuracy and safety.
We performed a systematic review and meta-analysis to determine the safety and accuracy of percutaneous RTB for the diagnosis of malignancy, histologic tumour subtype, and grade.
Medline, Embase, and Cochrane Library were searched for studies providing data on diagnostic accuracy and complications of percutaneous core biopsy (CB) or fine-needle aspiration (FNA) of renal tumours. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for diagnosis of malignancy. The Cohen kappa coefficient (κ) was estimated for the analysis of histotype/grade concordance between diagnosis on RTB and surgical specimen. Risk of bias assessment was performed (QUADAS-2).
A total of 57 studies recruiting 5228 patients were included. The overall median diagnostic rate of RTB was 92%. The sensitivity and specificity of diagnostic CBs and FNAs were 99.1% and 99.7%, and 93.2% and 89.8%, respectively. A good (κ = 0.683) and a fair (κ = 0.34) agreement were observed between histologic subtype and Fuhrman grade on RTB and surgical specimen, respectively. A very low rate of Clavien ≥ 2 complications was reported. Study limitations included selection and differential-verification bias.
RTB is safe and has a high diagnostic yield in experienced centres. Both CB and FNA have good accuracy for the diagnosis of malignancy and histologic subtype, with better performance for CB. The accuracy for Fuhrman grade is fair. Overall, the quality of the evidence was moderate. Prospective cohort studies recruiting consecutive patients and using homogeneous reference standards are required.
We systematically reviewed the literature to assess the safety and diagnostic performance of renal tumour biopsy (RTB). The results suggest that RTB has good accuracy in diagnosing renal cancer and its subtypes, and it appears to be safe. However, the quality of evidence was moderate, and better quality studies are required to provide a more definitive answer.
由于经皮肾肿瘤活检（RTB）在诊断准确性和安全性方面存在不确定性，其作用仍存在争议。
我们进行了一项系统评价和荟萃分析，以确定经皮RTB在诊断恶性肿瘤、组织学肿瘤亚型和分级方面的安全性和准确性。
检索了Medline、Embase和Cochrane图书馆，查找提供经皮肾肿瘤粗针活检（CB）或细针穿刺抽吸（FNA）诊断准确性和并发症数据的研究。进行荟萃分析以获得诊断恶性肿瘤的敏感性和特异性的合并估计值。估计Cohen kappa系数（κ）用于分析RTB诊断与手术标本之间的组织学类型/分级一致性。进行了偏倚风险评估（QUADAS-2）。
共纳入57项研究，涉及5228例患者。RTB的总体中位诊断率为92%。诊断性CB和FNA的敏感性和特异性分别为99.1%和99.7%，以及93.2%和89.8%。RTB与手术标本在组织学亚型和Fuhrman分级上分别观察到良好（κ = 0.683）和一般（κ = 0.34）的一致性。报告的Clavien≥2级并发症发生率非常低。研究局限性包括选择偏倚和差异验证偏倚。
在经验丰富的中心，RTB是安全的，诊断率高。CB和FNA对恶性肿瘤和组织学亚型的诊断均具有良好的准确性，CB的表现更好。Fuhrman分级的准确性一般。总体而言，证据质量中等。需要开展招募连续患者并使用同质参考标准的前瞻性队列研究。
我们系统回顾了文献，以评估肾肿瘤活检（RTB）的安全性和诊断性能。结果表明，RTB在诊断肾癌及其亚型方面具有良好的准确性，且似乎是安全的。然而，证据质量中等，需要更高质量的研究来提供更明确的答案。
