Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance

A systematic review

Catherine Paterson, Joesph Ghaemi, Abduelmenem Alashkham, Chandra Shekhar Biyani, Bernadette Coles, Lee Baker, Magdalena Szewczyk-Bieda, Ghulam Nabi (Lead / Corresponding author)

Research output: Contribution to journalReview article

Abstract

Objectives: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses only <4cm using 3x2 table, intention to diagnose approach. 3x2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2x2 table (four-cell matrix)approach.
Methods and Materials: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2x2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3x2 table for pooled estimates of the sensitivity and specificity.
Results: A total of 20 studies were included, with a total sample size of 974. Thepooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2x2 table observed sensitivity .952 (CI 0.908 - 0.979) and specificity 0.824 (CI 0.566 - 0.962). Using the 3x2 table and intention-to-diagnose principle, sensitivity .947(CI 0.925 - 0.965) and specificity 0.609 (CI 0.385 - 0.803) decreased.
Conclusions: Renal tumour biopsy in small renal masses (<4cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3×2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards.
Advances in Knowledge: A comprehensive synthesis of literature on image guided biopsies in small renal masses using a different methodology and study design
Original languageEnglish
Article number20170761
Pages (from-to)1-15
Number of pages15
JournalBritish Journal of Radiology
Volume91
Issue number1090
DOIs
Publication statusPublished - 31 Aug 2018

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Image-Guided Biopsy
Kidney
Biopsy
Sensitivity and Specificity
MEDLINE
Sample Size
Libraries
Neoplasms
Databases
Prospective Studies
Safety
Research
Population

Keywords

  • Small renal masses
  • renal tumour biopsy
  • accuracy
  • diagnosis
  • needle core biopsy
  • systematic review

Cite this

Paterson, Catherine ; Ghaemi, Joesph ; Alashkham, Abduelmenem ; Biyani, Chandra Shekhar ; Coles, Bernadette ; Baker, Lee ; Szewczyk-Bieda, Magdalena ; Nabi, Ghulam. / Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance : A systematic review. In: British Journal of Radiology. 2018 ; Vol. 91, No. 1090. pp. 1-15.
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title = "Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance: A systematic review",
abstract = "Objectives: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses only <4cm using 3x2 table, intention to diagnose approach. 3x2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2x2 table (four-cell matrix)approach.Methods and Materials: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2x2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3x2 table for pooled estimates of the sensitivity and specificity.Results: A total of 20 studies were included, with a total sample size of 974. Thepooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2x2 table observed sensitivity .952 (CI 0.908 - 0.979) and specificity 0.824 (CI 0.566 - 0.962). Using the 3x2 table and intention-to-diagnose principle, sensitivity .947(CI 0.925 - 0.965) and specificity 0.609 (CI 0.385 - 0.803) decreased.Conclusions: Renal tumour biopsy in small renal masses (<4cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3×2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards.Advances in Knowledge: A comprehensive synthesis of literature on image guided biopsies in small renal masses using a different methodology and study design",
keywords = "Small renal masses, renal tumour biopsy, accuracy, diagnosis, needle core biopsy, systematic review",
author = "Catherine Paterson and Joesph Ghaemi and Abduelmenem Alashkham and Biyani, {Chandra Shekhar} and Bernadette Coles and Lee Baker and Magdalena Szewczyk-Bieda and Ghulam Nabi",
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Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance : A systematic review. / Paterson, Catherine; Ghaemi, Joesph; Alashkham, Abduelmenem; Biyani, Chandra Shekhar; Coles, Bernadette; Baker, Lee; Szewczyk-Bieda, Magdalena; Nabi, Ghulam (Lead / Corresponding author).

In: British Journal of Radiology, Vol. 91, No. 1090, 20170761, 31.08.2018, p. 1-15.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Diagnostic accuracy of image guided biopsies in small (<4cm) renal masses with implications for active surveillance

T2 - A systematic review

AU - Paterson, Catherine

AU - Ghaemi, Joesph

AU - Alashkham, Abduelmenem

AU - Biyani, Chandra Shekhar

AU - Coles, Bernadette

AU - Baker, Lee

AU - Szewczyk-Bieda, Magdalena

AU - Nabi, Ghulam

N1 - Funding: Chief Scientist Office (CZG/2/343)

PY - 2018/8/31

Y1 - 2018/8/31

N2 - Objectives: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses only <4cm using 3x2 table, intention to diagnose approach. 3x2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2x2 table (four-cell matrix)approach.Methods and Materials: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2x2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3x2 table for pooled estimates of the sensitivity and specificity.Results: A total of 20 studies were included, with a total sample size of 974. Thepooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2x2 table observed sensitivity .952 (CI 0.908 - 0.979) and specificity 0.824 (CI 0.566 - 0.962). Using the 3x2 table and intention-to-diagnose principle, sensitivity .947(CI 0.925 - 0.965) and specificity 0.609 (CI 0.385 - 0.803) decreased.Conclusions: Renal tumour biopsy in small renal masses (<4cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3×2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards.Advances in Knowledge: A comprehensive synthesis of literature on image guided biopsies in small renal masses using a different methodology and study design

AB - Objectives: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses only <4cm using 3x2 table, intention to diagnose approach. 3x2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2x2 table (four-cell matrix)approach.Methods and Materials: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966 to 2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2x2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3x2 table for pooled estimates of the sensitivity and specificity.Results: A total of 20 studies were included, with a total sample size of 974. Thepooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2x2 table observed sensitivity .952 (CI 0.908 - 0.979) and specificity 0.824 (CI 0.566 - 0.962). Using the 3x2 table and intention-to-diagnose principle, sensitivity .947(CI 0.925 - 0.965) and specificity 0.609 (CI 0.385 - 0.803) decreased.Conclusions: Renal tumour biopsy in small renal masses (<4cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3×2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards.Advances in Knowledge: A comprehensive synthesis of literature on image guided biopsies in small renal masses using a different methodology and study design

KW - Small renal masses

KW - renal tumour biopsy

KW - accuracy

KW - diagnosis

KW - needle core biopsy

KW - systematic review

U2 - 10.1259/bjr.20170761

DO - 10.1259/bjr.20170761

M3 - Review article

VL - 91

SP - 1

EP - 15

JO - British Journal of Radiology

JF - British Journal of Radiology

SN - 0007-1285

IS - 1090

M1 - 20170761

ER -