Биопсия почечных опухолей подтвердила высокую точность диагностики и безопасность процедуры

Renal tumor biopsy refines diagnosis and supports individualized decision-making, according to a contemporary systematic review and meta-analysis. “A key practical implication of these findings is that RTB appears most reliable for answering the binary question of importance for both patients and treating clinicians of whether the lesion is cancerous or benign,” Carlotta Palumbo, MD, of the University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy, and colleagues wrote in European Urology, but it appears less accurate in determining tumor aggressiveness. The study (CRD420251180430) culled data from 103 studies reporting diagnostic accuracy, complications, and clinical impact of RTB in patients with localized or metastatic renal masses. The researchers assessed diagnostic performance and evaluated concordance between biopsy and surgical specimens. Indications for RTB included candidacy for watchful waiting/active surveillance or ablative treatment, suspected non-renal tumors, and selection of partial vs radical nephrectomy surgery. Across 88 evaluable studies, the pooled diagnostic yield of RTB was 0.90 (95% CI, 0.89-0.92). The overall sensitivity for malignancy was 0.99 (95% CI, 0.98-1.00) and specificity was 0.85 (95% CI, 0.64-0.95). RTB and surgical pathology highly correlated for benign vs malignant disease (0.96; 95% CI, 0.95-0.97) and histological subtype (0.89; 95% CI, 0.85-0.93). Grade concordance was lower using 4-tier grading (0.64; 95% CI, 0.60-0.67) and 2-tier grading (0.78; 95% CI, 0.70-0.84). RTB results led to changes in clinical management, including treatment change (39%; 95% CI, 30-49%) and treatment avoidance (28%; 95% CI, 24-32%). The complication rate after RTB was 3% (95% CI, 2-4%). The rate of Clavien-Dindo grade 3 or higher complications was less than 1%. The pooled bleeding rate was 1% (95% CI, 0-1%). Embolization for bleeding was required in 2 cases. Among studies reporting on tumor seeding rates, 1 study reported a rate of 5.7%, whereas the others reported no seeding events; the pooled seeding proportion was 0% (upper 95% CI, close to 0%). The risk of study bias was 73.8%. Overall, 9 studies (8.7%) caused some concern. High risk of bias was mostly attributed to patient selection and flow/timing. “This updated meta-analysis confirms that RTB is high-yield and safe, with excellent sensitivity for malignancy, high concordance for benign/malignant classification and histotype, and moderate reliability for tumor grade,” Dr Palumbo’s team wrote. This article originally appeared on Renal and Urology News