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- Title
Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone.
- Authors
Chen, Heather I.-Hsuan; Lapadat, Razvan; Lastra, Ricardo R.; Biernacka, Anna; Reeves, Ward; Mueller, Jeffrey; Pambuccian, Stefan E.; Barkan, Güliz A.; Wojcik, Eva M.; Antic, Tatjana
- Abstract
Background: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73–94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. Design: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss' Kappa and Cohen's Kappa equations were used to look at inter-rater variability. Results: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss' Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. Conclusions: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.
- Subjects
RENAL cell carcinoma; STATISTICS; STAINS &; staining (Microscopy); NEPHRECTOMY; CYTODIAGNOSIS; DESCRIPTIVE statistics; NEEDLE biopsy; TUMOR grading; EVALUATION
- Publication
Acta Cytologica, 2021, Vol 65, Issue 2, p140
- ISSN
0001-5547
- Publication type
Article
- DOI
10.1159/000513065