The Evaluation of Renal Tumor Diagnostics in Global Pathology Practice

Background The 2022 World Health Organization (WHO) fifth Edition introduced major revisions to renal neoplasm classification, incorporating novel and molecularly defined entities. However, the extent to which these advances are adopted in routine pathology practice remains unclear. This international survey evaluated the global diagnostic work-up of kidney tumors, including access to ancillary tests (immunohistochemistry [IHC], fluorescence in situ hybridization [FISH], next-generation sequencing [NGS]) and familiarity with the current classification. Methods A 30-question online survey was distributed via SurveyMonkey to pathologists involved in renal tumor diagnostics between January and July 2024. The survey assessed demographics, practice setting, training background, WHO classification familiarity, and availability of IHC and molecular testing. Responses were analyzed using descriptive and inferential statistics. Results Of 427 respondents, 399 (94.8%) reported encountering kidney tumors and were included, representing 45 countries. The most represented were the United States (18.8%), Egypt (15.8%), Turkey (12.6%), the United Kingdom (8.8%), and India (7.3%). Nearly half (49.4%) had >10 years of practice, 41.1% lacked formal genitourinary pathology training, and 70.7% worked in academic settings. IHC was widely available (96.0%), whereas access to FISH (50.1%) and NGS (43.8%) was limited. High-resource academic centers had significantly greater access to molecular diagnostics than community settings (all p < .001). Kidney-specific molecular panels were available in only 18.1% of institutions. Emerging biomarkers (SDHB, FH, cathepsin K, TFE3, TRIM63) were substantially less available than conventional markers. Although 66.3% reported familiarity with the WHO classification, 33.6% cited barriers such as rapid updates, financial constraints, and workload. Conclusions Marked global disparities persist in renal tumor diagnostics. While IHC is widely accessible, advanced molecular tools and novel biomarkers remain unevenly distributed, underscoring the need for targeted educational and resource-sharing strategies.