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Diagnostic accuracy of image guided biopsies of 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


Catherine Paterson

Joseph Ghaemi

Abduelmenem Alashkham

Chandra Shekhar Biyani

Bernadette Coles

Lee Baker

Magdalena Szewczyk-Bieda

Ghulam Nabi


The objective of this study was to determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only < 4cm using a 3 x 2 table intention-to-diagnose approach. The 3 x 2 table approach examines indeterminate results as a separate category, rather than pushing these through traditional a 2 x 2 table (four-cell matrix) approach. 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). The search sought 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 a conventional 2 x 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 x 2 table for pooled estimates of the sensitivity and specificity. A total of twenty studies were included, with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using a 2 x 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 x 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. In conclusion, renal tumour biopsy in SRMs < 4cm is associated with a high diagnostic sensitivity, but poor specificity when non-diagnostic results are included by a 3 x 2 table for analysis (intention-to-diagnose approach). The 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.


PATERSON, C., GHAEMI, J., ALASHKHAM, A., BIYANI, C.S., COLES, B., BAKER, L., SZEWCZYK-BIEDA, M. and NABI, G. 2018. Diagnostic accuracy of image guided biopsies of small ( < 4 cm) renal masses with implications for active surveillance: a systematic review of the evidence. British journal of radiology [online], 91(1090), article ID 20170761. Available from:

Journal Article Type Article
Acceptance Date Jun 5, 2018
Online Publication Date Aug 31, 2018
Publication Date Aug 31, 2018
Deposit Date Jun 7, 2018
Publicly Available Date Sep 1, 2019
Journal British journal of radiology
Print ISSN 0007-1285
Electronic ISSN 1748-880X
Publisher British Institute of Radiology
Peer Reviewed Peer Reviewed
Volume 91
Issue 1090
Article Number 20170761
Keywords Small renal masses; Renal tumour biopsy; Accuracy; Diagnosis; Needle core biopsy
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