Department of Urology, Region Västmanland - Uppsala University, Center for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden.
Centre for Clinical Research, Region Västmanland/Uppsala University, Västerås, Sweden; Division of Surgery, Danderyd University Hospital, Stockholm, Sweden.
Scand J Urol. 2024 Sep 11;59:141-146. doi: 10.2340/sju.v59.40844.
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.
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.
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.
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.
评估小肾肿块（SRM）患者行肾肿瘤活检（RTB）的安全性和诊断准确性，并评估 RTB 是否能防止良性 SRM 患者的过度治疗。
在瑞典韦斯特曼兰的一项回顾性单中心研究中，纳入了 195 例 2010 年至 2023 年期间因 SRM≤4cm 而行 RTB 的成年患者（69 名女性和 126 名男性）。中位年龄为 70 岁（范围 23-89 岁）。使用最终诊断作为参考标准，计算 RTB 的敏感性、特异性和预测值。中位随访 42 个月时记录治疗结果。根据 Clavien-Dindo 系统评估活检后的并发症。
RTB 的总体敏感性为 95%（95%置信区间 [CI] 90%-98%），特异性为 100%（95% CI 95%-100%）。阳性预测值为 100%，阴性预测值为 92%。使用 Kappa 统计测量 RTB 与最终诊断之间的一致性率为 0.92。在 195 例患者中，62 例行手术，48 例行消融治疗。手术前后 RTB 组织学与最终组织学的一致性率为 89%。在 67 例 RTB 为良性或不确定的患者中，治疗被推迟。在随访期间，没有患者发生肾细胞癌或转移。两名患者发生了 Clavien-Dindo 分级 I 和 IV 的并发症。
经皮肾肿瘤活检似乎是一种安全的诊断方法，可提供关于小肾肿块的准确组织病理学信息，并减少良性 SRM 的过度治疗。
