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

A systematic review of the evidence

Catherine Paterson, Joseph Ghaemi, Abduelmenem Alashkham, Chandra Shekhar Biyani, Bernadette Coles, Lee Baker, Magdalena Szewczyk-Bieda, Ghulam Nabi

Research output: Contribution to journalReview article

Abstract

Objective: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. methods: 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 (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. Results: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. conclusion: RTB in SRMs (<4 cm) 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 SRMs 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 - 1 Jan 2018
Externally publishedYes

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

Cite this

Paterson, Catherine ; Ghaemi, Joseph ; Alashkham, Abduelmenem ; Biyani, Chandra Shekhar ; Coles, Bernadette ; Baker, Lee ; Szewczyk-Bieda, Magdalena ; Nabi, Ghulam. / Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance : A systematic review of the evidence. In: British Journal of Radiology. 2018 ; Vol. 91, No. 1090. pp. 1-15.
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abstract = "Objective: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. methods: 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 (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. Results: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. conclusion: RTB in SRMs (<4 cm) 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 SRMs using a different methodology and study design.",
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Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance : A systematic review of the evidence. / Paterson, Catherine; Ghaemi, Joseph; Alashkham, Abduelmenem; Biyani, Chandra Shekhar; Coles, Bernadette; Baker, Lee; Szewczyk-Bieda, Magdalena; Nabi, Ghulam.

In: British Journal of Radiology, Vol. 91, No. 1090, 20170761, 01.01.2018, p. 1-15.

Research output: Contribution to journalReview article

TY - JOUR

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

T2 - A systematic review of the evidence

AU - Paterson, Catherine

AU - Ghaemi, Joseph

AU - Alashkham, Abduelmenem

AU - Biyani, Chandra Shekhar

AU - Coles, Bernadette

AU - Baker, Lee

AU - Szewczyk-Bieda, Magdalena

AU - Nabi, Ghulam

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. methods: 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 (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. Results: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. conclusion: RTB in SRMs (<4 cm) 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 SRMs using a different methodology and study design.

AB - Objective: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. methods: 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 (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. Results: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. conclusion: RTB in SRMs (<4 cm) 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 SRMs using a different methodology and study design.

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U2 - 10.1259/bjr.20170761

DO - 10.1259/bjr.20170761

M3 - Review article

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JO - British Journal of Radiology

JF - British Journal of Radiology

SN - 0007-1285

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