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.
European urology. 2026 Jul 24 [Epub ahead of print]
Georges Mjaess, Michele Nicolazzini, Daniele Amparore, Axel Bex, Riccardo Campi, Francesco Cei, Sabrina L Noyes, Chiara Re, Giuseppe Rosiello, Grant D Stewart, Alessandro Volpe, Carlotta Palumbo, European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group
Department of Urology, Brussels University Hospital, Brussels, Belgium., Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy; Department of Oncology, University of Turin, Orbassano, Turin, Italy., Department of Oncology, University of Turin, Orbassano, Turin, Italy; Division of Urology, Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy., The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urology and Renal Transplantation, Oncology Department, Careggi University Hospital, Florence, Italy; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Division of Urology, Corewell Health West, Grand Rapids, Michigan, USA., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Surgery, University of Cambridge, Cambridge, UK., Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Surgery, University of Cambridge, Cambridge, UK., Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy. Electronic address: .