Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10‐year retrospective review

Abstract

Background The number of “renal incidentalomas” is on the rise due to increasing use of radiologic studies. Image‐guided core needle biopsies (CNB) with touch preparations are performed to guide specimen collection and triage of sample for additional studies. Results allow the clinical team to make appropriate treatment decisions. Design Our electronic database was searched for a 10‐year period to identify 180 image‐guided biopsies of renal masses with rapid on‐site evaluations (ROSE) and corresponding biopsy/resection specimens. Touch preparations were classified as non‐diagnostic, negative/benign, adequate/positive for malignancy/oncocytic predominance, or atypical. These results were compared to the final diagnosis on the biopsy or resection specimen (if available). Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Non‐diagnostic cases and cases in which ROSE and final diagnosis were discordant were reviewed by cytopathologists blinded to the original interpretation to reconcile discrepancies and highlight interpretation pitfalls. Results A ROSE diagnosis was rendered in 133 of 180 cases; 47 cases were non‐diagnostic. Of the 133 diagnostic cases, the ROSE diagnosis was concordant with the core biopsy final diagnosis in 125 cases, yielding a diagnostic accuracy of 94%. The overall sensitivity was calculated to be 80.1%; specificity 72.4%; positive predictive value 94%; and negative predictive value 41.2%. Conclusions Touch preparation slides are vital but imperfect tools in evaluating renal masses. In our study, distinction between malignant and benign samples was accomplished in most cases (94% accuracy), but there are limitations. Awareness of interpretation pitfalls allows informed decisions to be made regarding specimen collection and patient management.

Role of renal mass biopsy for diagnosis and management: Review of current trends and future directions

“…A limited number of studies have examined performance of the ROSE preliminary impression compared with the final diagnosis of renal masses. The diagnostic accuracy of ROSE performed on FNA and/or touch preparations of RMB is reported to be in the range of 85%–95% 43,46–48 . One study examined both FNA and core biopsies with touch preparations and found that ROSE had high sensitivity and positive predictive value (96% and 98.5%, respectively) in adequate specimens for a definitive diagnosis 43 .…”

“…The diagnostic accuracy of ROSE performed on FNA and/or touch preparations of RMB is reported to be in the range of 85%-95%. 43,[46][47][48] One study examined both FNA and core biopsies with touch preparations and found that ROSE had high sensitivity and positive predictive value (96% and 98.5%, respectively) in adequate specimens for a definitive diagnosis. 43 Nondiagnostic ROSE was found to have sufficient material to be diagnostic on final diagnosis in 15% of cases.…”

“…Another study on ROSE performed on touch preparations of renal core biopsies reported that overall sensitivity was 80.1%, specificity was 72.4%, the positive predictive value was 94%, and the negative predictive value was 41.2%. 47 A subset of those were core biopsies performed on cystic masses, of which 58.3% were nondiagnostic at the time of ROSE but had sufficient material for diagnosis on permanent sections. Comparing FNA and core biopsy with touch preparations, core biopsy had higher adequacy than FNA by ROSE.…”

“…Nondiagnostic ROSE was found to have sufficient material to be diagnostic on final diagnosis in 15% of cases. Another study on ROSE performed on touch preparations of renal core biopsies reported that overall sensitivity was 80.1%, specificity was 72.4%, the positive predictive value was 94%, and the negative predictive value was 41.2% 47 . A subset of those were core biopsies performed on cystic masses, of which 58.3% were nondiagnostic at the time of ROSE but had sufficient material for diagnosis on permanent sections.…”