**6. Investigating biomarkers**

Recent studies have explored the merits of molecular biomarkers to improve diagnostic classification of RTBs. A recent systematic evaluation by Gulati et al. [25] assessed cancer-specific survival (**CSS**) in 350 ccRCC patients with 28 published genetic biomarkers. Seventeen of these genetic and transcriptomic prognostic ccRCC markers were validated as predictors of CSS. A comprehensive review article by Farber et al. [26] shows the many other areas where biomarkers are being developed: PET imaging, MRI, serum biomarkers, urine biomarkers, liquid biopsy and immunohistochemistry. Of particular interest is the staining method for CK7 that is expressed in both chRCC and oncocytoma. In the former it is strongly and diffusely positive, while in the latter, only focal positivity or no staining is observed [18, 26, 27]. With further prospective clinical studies, a combinatorial approach can be adopted to discern the heterogeneous nature of renal lesions.

**Author details**

**References**

Menazir Sha and Faiz Mumtaz\*

\*Address all correspondence to: faiz.mumtaz@nhs.net

Specialist Kidney Centre, Royal Free Hospital, London, United Kingdom

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