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Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases
  1. Susan Prendeville1,2,
  2. Patrick O Richard3,4,
  3. Michael A S Jewett3,
  4. John R Kachura5,
  5. Joan M Sweet1,
  6. Theodorus H van der Kwast1,
  7. Carol C Cheung1,
  8. Antonio Finelli3,
  9. Andrew John Evans1
  1. 1 Department of Pathology, University Health Network, Toronto, Ontario, Canada
  2. 2 Department of Pathology, Cork University Hospital, Cork, Ireland
  3. 3 Division of Urology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
  4. 4 Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada
  5. 5 Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Susan Prendeville, Department of Pathology, University Health Network, Toronto, ON M5G 2C4, Canada; susanaprendeville{at}gmail.com

Abstract

Aims Renal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.

Methods This single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).

Results We observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.

Conclusion There was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.

  • kidney
  • renal cancer
  • uropathology
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Footnotes

  • Handling editor Runjan Chetty.

  • Contributors SP, POR, AF and AJE contributed to study design. SP and AJE drafted the manuscript. All authors contributed to data collection, edited and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Full institutional approval for the study was obtained from the UHN Research Ethics Board (REB no 13–7198-CE).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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