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Editorial Comment on: Cytological Punctures in Diagnosis of Renal Tumours: A Study on Accuracy and Reproducibility
european urology 55 (2009) 187–198
[22] Mun˜oz SR, Bangdiwala SI. Interpretation of Kappa and B statistics measures of agreement. J Appl Statistics 1997;24:105–11. [23] Reichelt O, Gajda M, Chyhrai A, et al. Ultrasound-guided biopsy of homogeneous solid renal masses. Eur Urol 2007;52:1421–7. [24] Kunkle DA, Crispen PL, Chen DY, Greenberg RE, Uzzo RG. Enhancing renal masses with zero net growth during active surveillance. J Urol 2007;177:849–53. [25] Siu W, Hafez KS, Johnston III WK, Wolf Jr JS. Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 2007;25:115–9. [26] Granter SR, Perez-Atayde AR, Renshaw AA. Cytologic analysis of papillary renal cell carcinoma. Cancer 1998;84:303–8. [27] Granter SR, Renshaw AA. Cytologic analysis of renal angiomyolipoma: a comparison of radiologically classic and challenging cases. Cancer 1999;87:135–40.
Editorial Comment on: Cytological Punctures in Diagnosis of Renal Tumours: A Study on Accuracy and Reproducibility Eric Lechevallier Department of Urology, Hoˆpital La Conception, Marseille, France [email protected] There is growing evidence that management of renal masses can be tailored to the patient according to nonoperative parameters, such as renal histology, especially in elderly and unfit patients [1]. With advances in interventional radiology and renal pathology, core renal biopsies have replaced fine needle aspiration (FNA), the first nonsurgical tool to evaluate solid renal masses [2,3]. Nevertheless, with a global accuracy rate close to 90%, core biopsy had some limits, and FNA could be an auxiliary nonsurgical tool to increase the diagnostic accuracy of core biopsy [1]. Ku¨mmerlin et al evaluated the role of FNA in the diagnosis of solid renal masses [4]. In this series, with 66 consecutive renal tumours, they showed that FNA, performed in-bench, had an overall accuracy close to 90%. The overall pathologic concordance of FNA was 70%. But FNA was not as good as core biopsy for subtype histology and grade of renal cancer [2,3]. Nevertheless, tumour grade evaluation of core biopsy was not optimal (75%) [2,3]. From this paper, it appears that FNA and
195
[28] Liu J, Fanning CV. Can renal oncocytomas be distinguished from renal cell carcinoma on fine-needle aspiration specimens? A study of conventional smears in conjunction with ancillary studies. Cancer 2001;93: 390–7. [29] Salamanca J, Alberti N, Lopez-Rios F, et al. Fine needle aspiration of chromophobe renal cell carcinoma. Acta Cytol 2007;51:9–15. [30] Wiatrowska BA, Zakowski MF. Fine-needle aspiration biopsy of chromophobe renal cell carcinoma and oncocytoma: comparison of cytomorphologic features. Cancer 1999;87:161–7. [31] Granter SR, Renshaw AA. Fine-needle aspiration of chromophobe renal cell carcinoma. Analysis of six cases. Cancer 1997;81:122–8. [32] Volpe A, Kachura JR, Geddie WR, et al. Techniques, safety and accuracy of sampling of renal tumours by fine needle aspiration and core biopsy. J Urol 2007;178:379–86.
core biopsy are not competitive, but rather complementary, tools. We can well speculate that, in the future, the nonsurgical evaluation of solid renal masses might combine core biopsy and FNA to increase the accuracy of preoperative evaluation of renal masses.
References [1] Volpe A, Kachura JR, Geddie WR, et al. Techniques, safety, and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 2007;178: 379–86. [2] Lechevallier E, Andre M, Barriol D, et al. Fine needle percutaneous biopsy of renal masses with helical CT guidance. Radiology 2000;216:506–10. [3] Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C. Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 2004;171: 1802–5. [4] Ku¨mmerlin IPED, Smedts F, ten Kate FJW, et al. Cytological punctures in diagnosis of renal tumours: a study on accuracy and reproducibility. Eur Urol 2009;55: 187–98.
DOI: 10.1016/j.eururo.2008.04.073 DOI of original article: 10.1016/j.eururo.2008.04.072
[22] Mun˜oz SR, Bangdiwala SI. Interpretation of Kappa and B statistics measures of agreement. J Appl Statistics 1997;24:105–11. [23] Reichelt O, Gajda M, Chyhrai A, et al. Ultrasound-guided biopsy of homogeneous solid renal masses. Eur Urol 2007;52:1421–7. [24] Kunkle DA, Crispen PL, Chen DY, Greenberg RE, Uzzo RG. Enhancing renal masses with zero net growth during active surveillance. J Urol 2007;177:849–53. [25] Siu W, Hafez KS, Johnston III WK, Wolf Jr JS. Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 2007;25:115–9. [26] Granter SR, Perez-Atayde AR, Renshaw AA. Cytologic analysis of papillary renal cell carcinoma. Cancer 1998;84:303–8. [27] Granter SR, Renshaw AA. Cytologic analysis of renal angiomyolipoma: a comparison of radiologically classic and challenging cases. Cancer 1999;87:135–40.
Editorial Comment on: Cytological Punctures in Diagnosis of Renal Tumours: A Study on Accuracy and Reproducibility Eric Lechevallier Department of Urology, Hoˆpital La Conception, Marseille, France [email protected] There is growing evidence that management of renal masses can be tailored to the patient according to nonoperative parameters, such as renal histology, especially in elderly and unfit patients [1]. With advances in interventional radiology and renal pathology, core renal biopsies have replaced fine needle aspiration (FNA), the first nonsurgical tool to evaluate solid renal masses [2,3]. Nevertheless, with a global accuracy rate close to 90%, core biopsy had some limits, and FNA could be an auxiliary nonsurgical tool to increase the diagnostic accuracy of core biopsy [1]. Ku¨mmerlin et al evaluated the role of FNA in the diagnosis of solid renal masses [4]. In this series, with 66 consecutive renal tumours, they showed that FNA, performed in-bench, had an overall accuracy close to 90%. The overall pathologic concordance of FNA was 70%. But FNA was not as good as core biopsy for subtype histology and grade of renal cancer [2,3]. Nevertheless, tumour grade evaluation of core biopsy was not optimal (75%) [2,3]. From this paper, it appears that FNA and
195
[28] Liu J, Fanning CV. Can renal oncocytomas be distinguished from renal cell carcinoma on fine-needle aspiration specimens? A study of conventional smears in conjunction with ancillary studies. Cancer 2001;93: 390–7. [29] Salamanca J, Alberti N, Lopez-Rios F, et al. Fine needle aspiration of chromophobe renal cell carcinoma. Acta Cytol 2007;51:9–15. [30] Wiatrowska BA, Zakowski MF. Fine-needle aspiration biopsy of chromophobe renal cell carcinoma and oncocytoma: comparison of cytomorphologic features. Cancer 1999;87:161–7. [31] Granter SR, Renshaw AA. Fine-needle aspiration of chromophobe renal cell carcinoma. Analysis of six cases. Cancer 1997;81:122–8. [32] Volpe A, Kachura JR, Geddie WR, et al. Techniques, safety and accuracy of sampling of renal tumours by fine needle aspiration and core biopsy. J Urol 2007;178:379–86.
core biopsy are not competitive, but rather complementary, tools. We can well speculate that, in the future, the nonsurgical evaluation of solid renal masses might combine core biopsy and FNA to increase the accuracy of preoperative evaluation of renal masses.
References [1] Volpe A, Kachura JR, Geddie WR, et al. Techniques, safety, and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 2007;178: 379–86. [2] Lechevallier E, Andre M, Barriol D, et al. Fine needle percutaneous biopsy of renal masses with helical CT guidance. Radiology 2000;216:506–10. [3] Neuzillet Y, Lechevallier E, Andre M, Daniel L, Coulange C. Accuracy and clinical role of fine needle percutaneous biopsy with computerized tomography guidance of small (less than 4.0 cm) renal masses. J Urol 2004;171: 1802–5. [4] Ku¨mmerlin IPED, Smedts F, ten Kate FJW, et al. Cytological punctures in diagnosis of renal tumours: a study on accuracy and reproducibility. Eur Urol 2009;55: 187–98.
DOI: 10.1016/j.eururo.2008.04.073 DOI of original article: 10.1016/j.eururo.2008.04.072