Systematic Review and Meta-analysis on Renal Tumor Biopsy: Accuracy, Safety, and Impact on Clinical Decision-making

We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy, safety, and clinical impact of renal tumor biopsy (RTB) in managing renal cell carcinoma.

MEDLINE, Embase, and Cochrane CENTRAL were systematically searched for studies evaluating diagnostic accuracy, complications, and clinical impact of RTB. Diagnostic performance was synthesized using hierarchical bivariate random-effects models; concordance between biopsy and surgical specimens was assessed using pooled proportions that were estimated using random-effects meta-analysis. Risk of bias was evaluated with QUADAS-2.

Overall, 103 studies were included. The pooled diagnostic yield of RTB was 90%. Summary sensitivity and specificity for malignancy were 99% and 85%, respectively. Concordance between RTB and surgical pathology was high for benign versus malignant (96%) and histological subtype (89%), but moderate for grade (four-tier: 64%; two-tier: 78%). The overall complication rate was low (3%), with negligible (<1%) Clavien-Dindo ≥3 complications and 1% bleeding events (with only two patients requiring embolization). Tumor seeding was reported only in one study with a pooled seeding proportion of 0%. RTB findings was associated with a change in clinical management in 39% of patients and avoidance of active treatment in 28%. Most studies were at high risk of bias, mainly due to patient selection and flow/timing, and were predominantly retrospective.

RTB is safe and high-yield, with excellent sensitivity, high concordance for benign vs malignant and histotype, but only moderate reliability for tumor grade. RTB is therefore an important aid in refining diagnosis in patients with a renal mass and supporting individualized decision-making.