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Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature

2016; Lippincott Williams & Wilkins; Volume: 195; Issue: 5 Linguagem: Inglês

10.1016/j.juro.2015.11.029

1527-3792

Hiten D. Patel, Michael H. Johnson, Phillip M. Pierorazio, Stephen M. Sozio, Ritu Sharma, Emmanuel Iyoha, Eric B Bass, Mohamad E. Allaf,

Cancer Genomics and Diagnostics

No AccessJournal of UrologyAdult Urology1 May 2016Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the Literature Hiten D. Patel, Michael H. Johnson, Phillip M. Pierorazio, Stephen M. Sozio, Ritu Sharma, Emmanuel Iyoha, Eric B. Bass, and Mohamad E. Allaf Hiten D. PatelHiten D. Patel James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Michael H. JohnsonMichael H. Johnson James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Phillip M. PierorazioPhillip M. Pierorazio James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland , Stephen M. SozioStephen M. Sozio Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland , Ritu SharmaRitu Sharma Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland , Emmanuel IyohaEmmanuel Iyoha Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland , Eric B. BassEric B. Bass Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland , and Mohamad E. AllafMohamad E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland View All Author Informationhttps://doi.org/10.1016/j.juro.2015.11.029AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Clinical practice varies widely on the diagnostic role of biopsy for clinically localized renal masses suspicious for renal cell carcinoma. Therefore, we performed a systematic review of the available literature to quantify the accuracy and rate of adverse events of renal mass biopsy. Materials and Methods: MEDLINE®, Embase® and the Cochrane databases were searched (January 1997 to May 2015) for relevant studies. The systematic review process established by the Agency for Healthcare Research and Quality was followed. Nondiagnostic biopsies were excluded from diagnostic accuracy calculations. Results: A total of 20 studies with 2,979 patients and 3,113 biopsies were included in the study. The overall nondiagnostic rate was 14.1% with 90.4% of those undergoing surgery found to have malignancy. Repeat biopsy led to diagnosis in 80% of patients. The false-positive rate was low (4.0%), histological and renal cell carcinoma subtype concordance was substantial, and Fuhrman upgrading notable (16%) from low grade (1 to 2) to high grade (3 to 4). Core biopsy was highly sensitive (97.5%, CI 96.5–98.5) and specific (96.2%, CI 90.7–100) when a diagnostic result was obtained, but most patients (∼80%) did not undergo surgery after a benign biopsy. Among patients undergoing extirpation 36.7% with a negative biopsy had malignant disease on surgical pathology (negative predictive value 63.3%, CI 52.4–74.2). Direct complications included hematoma (4.9%), clinically significant pain (1.2%), gross hematuria (1.0%), pneumothorax (0.6%) and hemorrhage (0.4%). 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Volume 195Issue 5May 2016Page: 1340-1347Supplementary Materials Advertisement Copyright & Permissions© 2016Keywordsbiopsycomplicationscarcinoma, renal celldata accuracydiagnosisAcknowledgmentsAllen Zhang and Emily Little provided assistance with data abstraction. In addition, the key informants, technical expert panel, peer reviewers, Dr. Steven Campbell and AHRQ task order officer Dr. Aysegul Gozu provided feedback and insights.MetricsAuthor Information Hiten D. Patel James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Michael H. Johnson James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Phillip M. Pierorazio James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Stephen M. Sozio Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Ritu Sharma Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland More articles by this author Emmanuel Iyoha Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland More articles by this author Eric B. Bass Johns Hopkins University Evidence-Based Practice Center, Baltimore, Maryland More articles by this author Mohamad E. Allaf James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland More articles by this author Expand All Advertisement PDF downloadLoading ...