Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta‐analysis

Abstract

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 RMBs 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 = 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.

Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study

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Contemporary surgical management of renal oncocytoma: a nation's outcome

“…However, due to shared morphological features between oncocytoma and chromophobe RCC, the distinction between both on biopsy can be challenging. In a recent systematic review, including 10 renal tumour biopsy series, a quarter of 46 cases initially diagnosed as oncocytic tumours on biopsy were found to be RCC after surgery . Nonetheless, equivocal biopsies were not distinguished from cases with more definitely benign features.…”

Modern Pathologic Diagnosis of Renal Oncocytoma

“…Unfortunately, oncocytic lesions can be especially troublesome in renal mass biopsy, as interpreting only a limited sampling of tumor may not be representative of the entire lesion. A meta-analysis of 205 oncocytic renal mass biopsies from 2017 showed that the positive predictive value for a diagnosis of oncocytoma on renal mass biopsy was 67% with significant heterogeneity and wide confidence interval, indicating that the diagnostic accuracy varies greatly between studies and, by extrapolation, between pathologists ( 41 ).…”