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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
Type
Published Article
Journal
Acta Cytologica
Publisher
S. Karger AG
Publication Date
Feb 03, 2021
Volume
65
Issue
2
Pages
140–149
Identifiers
DOI: 10.1159/000513065
PMID: 33535202
Source
Karger
Keywords
License
Green
External links

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.

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