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Concordance between renal tumour biopsy and robotic-assisted partial and radical nephrectomy histology: a 10-year experience

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Abstract

We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013–9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.

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Data availability statement

Anonymised dataset is available upon request.

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Acknowledgements

The authors would like to thank colleagues who provided institutional data on renal biopsy and nephrectomy cohorts, including (East and North Hertfordshire) Mrs Donna Piper, Mr Paul Barber, (Luton and Dunstable) Mr Andrew Taylor, (West Hertfordshire) Dr Shilpan Patel, and Dr Shiv Hadani.

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  1. Lister Hospital, Stevenage, SG1 4AB, UK

    Ned Kinnear, Anushree Kucheria, Catherine Ogbechie, Sana Adam, Omar Haidar, Paul Cotter Fonseca, Andrew Brodie, Ben Pullar & James Adshead

  2. University of Adelaide, Adelaide, Australia

    Ned Kinnear

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Contributions

NK created the concept. NK, AK, CO, SA, OH, PF and AB performed data collection. NK performed the statistical analyses. NK obtained ethics approval and wrote the first manuscript. BP and JA provided supervision. All authors refined the final manuscript and agreed to be accountable for all aspects of the work.

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Correspondence to Ned Kinnear.

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Kinnear, N., Kucheria, A., Ogbechie, C. et al. Concordance between renal tumour biopsy and robotic-assisted partial and radical nephrectomy histology: a 10-year experience. J Robotic Surg 18, 45 (2024). https://doi.org/10.1007/s11701-024-01821-0

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