Lister Hospital, Stevenage, SG1 4AB, UK.
University of Adelaide, Adelaide, Australia.
J Robot Surg. 2024 Jan 19;18(1):45. doi: 10.1007/s11701-024-01821-0.
We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013-9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.
我们旨在评估机器人辅助部分肾切除术（RAPN）或机器人辅助根治性肾切除术（RARN）中肾肿瘤活检（RTB）与手术病理的一致性。回顾性纳入 2013 年 9 月 9 日至 2023 年 9 月 9 日期间，在三个地点因疑似恶性肿瘤接受 RAPN 或 RARN 治疗的术前接受 RTB 的患者。如果肿瘤有既往冷冻治疗史，或者活检或肾切除术组织学不可用或不确定，则排除患者。主要结局是良恶性的一致性。次要结局是肿瘤亚型、世界卫生组织核分级（仅接受 RTB 透明细胞或乳头状 RCC 的患者）、假阴性率、假阳性率、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）的一致性。在入组期间，分别有 332 名和 132 名患者接受了 RAPN 和 RARN。其中，160 名患者接受了术前 RTB，9 名患者被排除，留下 151 名符合条件的患者。中位年龄为 63 岁，49 名（32%）为女性。在手术标本中，144 名患者的组织学为恶性。RTB 与良恶性的存在高度一致（147/151，97%）。141 名患者（93%）的肿瘤亚型一致，42/66 名患者（64%）的核分级一致（53 名患者的 RTB 分级缺失）。假阴性率、假阳性率、敏感性、特异性、PPV 和 NPV 分别为 2%、14%、98%、86%、99%和 67%。局限性包括缺乏并发症数据和排除未经手术活检的患者。在接受 RAPN 或 RARN 治疗的患者中，术前 RTB 在良恶性和 RCC 亚型方面与手术病理具有高度一致性。
