Department of Pathology, Ankara Bilkent City Hospital, Ankara, Turkey.
Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Cancer Cytopathol. 2024 Aug;132(8):510-524. doi: 10.1002/cncy.22826. Epub 2024 May 7.
The incidence of renal tumors has steadily increased over the past decade. In this study, the authors performed a systematic review and analysis of the literature on renal fine-needle aspiration (FNA) to determine its performance and explore whether a standardized classification system can be used for reporting renal FNA cytology.
A systematic search of published articles on renal FNA was conducted. The data on FNA and histologic diagnosis were extracted and categorized, and the risk of malignancy was calculated. Different scenarios were used to estimate FNA performance statistics.
Of the 3766 potentially relevant studies, 23 met the inclusion criteria of the study. The 2231 FNA cases included were re-categorized according to the classification system, rendering 142 (6.36%) nondiagnostic, 270 (12.1%) nonneoplastic, 271 (12.14%) benign neoplasm, 65 (2.91%) renal neoplasm with unknown malignant potential, oncocytic type, 25 (1.12%) atypia of undetermined significance, 60 (2.68%) suspicious for malignancy, and 1398 (62.66%) malignant FNA diagnoses. The risk of malignancy in these cases was 65.4%, 18.1%, 16.6%, 16.9%, 60%, 73.3%, and 96.9%, respectively. According to the classification system, the study indicated that the accuracy of renal FNA was between 91% and 95%, the sensitivity was 90.9%-96.7%, and the specificity was 82%-92% in different scenarios.
There is a need for a standardized reporting in renal cytology that will improve the sensitivity and accuracy of renal cytology, reduce the rate of indeterminate diagnoses, and alter the management strategies of renal lesions. Based on the available literature, a new reporting system is proposed, including categories with an associated risk of malignancy.
过去十年间，肾肿瘤的发病率稳步上升。本研究对肾细针穿刺（FNA）文献进行了系统回顾和分析，旨在评估其效能，并探讨是否可采用标准化分类系统对肾 FNA 细胞学报告进行规范。
系统检索了发表的肾 FNA 相关文献。提取 FNA 和组织学诊断数据并进行分类，计算恶性肿瘤风险。采用不同场景估计 FNA 效能统计量。
在 3766 篇潜在相关研究中，23 项研究符合纳入标准。对 2231 例 FNA 病例按分类系统重新分类，结果显示 142 例（6.36%）为非诊断性，270 例（12.1%）为非肿瘤性，271 例（12.14%）为良性肿瘤，65 例（2.91%）为肾肿瘤伴恶性潜能未确定的嗜酸细胞型，25 例（1.12%）为意义未明的非典型性，60 例（2.68%）为疑似恶性，1398 例（62.66%）为恶性 FNA 诊断。这些病例的恶性肿瘤风险分别为 65.4%、18.1%、16.6%、16.9%、60%、73.3%和 96.9%。按分类系统，本研究提示不同场景下肾 FNA 的准确率为 91%-95%，敏感度为 90.9%-96.7%，特异度为 82%-92%。
需要建立肾细胞学的标准化报告系统，以提高肾细胞学的敏感性和准确性，降低不确定诊断率，并改变肾病变的管理策略。基于现有文献，本研究提出了一种新的报告系统，包括与恶性肿瘤风险相关的分类。
