Systematic review and meta-analysis of 103 studies evaluating the diagnostic accuracy, safety, and clinical impact of renal tumor biopsy (RTB) in patients with renal masses suspected for renal cell carcinoma.
Pooled diagnostic yield was 90%; sensitivity for malignancy 99%, specificity 85%; benign vs. malignant concordance with surgical pathology 96%, histological subtype 89%, but grade concordance was only moderate (64% four-tier; 78% two-tier). Overall complication rate was 3%, with <1% Clavien-Dindo ≥3 events and 1% bleeding; tumor seeding pooled proportion was 0%. RTB changed clinical management in 39% of patients and avoided active treatment in 28%.
Majority of included studies were retrospective with high risk of bias driven by patient selection and flow/timing issues. Grading concordance was only moderate, limiting RTB's utility for grade-dependent treatment decisions.
RTB is safe and highly accurate for ruling in malignancy and identifying histological subtype — use it to guide individualized management, especially when avoiding unnecessary treatment matters. Grade concordance is only moderate, so biopsy grade alone should not drive decisions requiring precise grading.
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