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Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta‐analysis
Author(s) -
Patel Hiten D.,
Druskin Sasha C.,
Rowe Steven P.,
Pierorazio Phillip M.,
Gorin Michael A.,
Allaf Mohamad E.
Publication year - 2017
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13763
Subject(s) - oncocytoma , medicine , renal oncocytoma , histopathology , concordance , chromophobe cell , biopsy , renal mass , renal cell carcinoma , meta analysis , surgical pathology , pathology , radiology , kidney , clear cell , nephrectomy
To estimate the proportion of oncocytic renal neoplasms diagnosed on renal mass biopsy ( RMB ) confirmed on surgical pathology, a systematic review of MEDLINE , Embase, and the Cochrane databases (1997 to 1 July 2016) was conducted quantifying all cases of reported oncocytic renal neoplasms on RMB suggestive of an oncocytoma. In addition, institutional data was assessed to identify additional cases. Concordance with surgical histopathology (positive predictive value [ PPV ]) was evaluated for patients undergoing surgery by performing a meta‐analysis. In all, 10 RMB series, including institutional data, were included in the meta‐analysis with 205 RMB s identifying oncocytic renal neoplasms and 46 (22.4%) proceeding to surgery. One additional study identified two neoplasms not captured by the primary RMB series for a total of 48 unique lesions included in the analysis. Surgical pathology showed oncocytoma (64.6%), chromophobe renal cell carcinoma ( RCC ; 12.5%), other RCC (12.5%), hybrid oncocytic/chromophobe tumour (6.3%), and other benign lesions (4.2%). PPV of oncocytoma on RMB was 67% (95% confidence interval 34–94%) with significant heterogeneity between studies ( I 2 = 71.8%, P < 0.01). Risk of bias was judged to be low for four of the 10 series. Confidently diagnosing a localised renal mass as a benign lesion, such as an oncocytoma, has implications for the ultimate management strategy a patient will undergo. RMB was found to be unreliable in confidently diagnosing a localised renal mass as an oncocytoma, with one in four found to be RCC on surgical pathology. Patients and physicians should be aware of the uncertainty in diagnosis when considering management strategies.