Predictors of Delayed Intervention for Patients on Active Surveillance for Small Renal Masses: Does Renal Mass Biopsy Influence Our Decision?

Ambani, Sapan N.; Morgan, Todd M.; Montgomery, Jeffrey S.; Gadzinski, Adam J.; Jacobs, Bruce L.; Hawken, Scott; Krishnan, Naveen; Caoili, Elaine M.; Ellis, James H.; Kunju, Lakshmi P.; Hafez, Khaled S.; Miller, David C.; Palapattu, Ganesh S.; Weizer, Alon Z.; Wolf, J. Stuart

doi:10.1016/j.urology.2016.04.067

Cited by 26 publications

(30 citation statements)

References 25 publications

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“…A significant number of patients who proceed directly to aggressive surgical resection, but who truly have a nonmalignant or certain indolent malignant lesion, are potentially undergoing an unnecessary surgical procedure. [ 13 ] Meanwhile, in patients with a large locally advanced or metastatic renal malignancy, histological diagnosis before surgery is important in guiding oncologists to choose a suitable chemotherapy and/or radiotherapy regimen. [ 14 ] Furthermore, intravenous contrast agent is contraindicated in patients with chronic renal failure who are at risk of developing bilateral, multiple renal cell carcinomas, and these renal masses may be incompletely/only partially evaluated radiologically.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of ultrasound-guided percutaneous needle core biopsy of renal masses

Wang¹,

et al. 2018

Medicine

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Our aim is to determine the sufficiency, accuracy, and safety of ultrasound-guided percutaneous needle core biopsy of renal masses in Chinese patients.Patients who had undergone ultrasound-guided needle core renal mass biopsy from June 2012 to June 2016 at West China Hospital, China were retrospectively reviewed. The information obtained included demographics, mass-related parameters, biopsy indications, technique, complications, pathologic results, and follow-up. Concordance of surgical resection pathology and follow-up data were assessed.Renal mass biopsies were performed in 106 patients. Thirty-nine (36.8%) were asymptomatic. The male/female ratio was 60/46, with a median age of 49.5 years. Median mass size was 8.1 cm (range 1.8–20). Biopsy was performed through a 16-gauge needle, with median cores of 2 taken (range 1–5). Only one significant biopsy-related complication (hemorrhage requiring transfusion) was encountered. An adequate tissue sample was obtained in 97.2% (103/106) of biopsies. Eighty-seven biopsies (82.1%) showed malignant neoplasms, 16 (15.1%) yielded benignity, and 3 (2.8%) were nondiagnostic. After biopsy, 46 patients (43.4%) underwent surgery. Compared with the subsequent mass resection pathology, the biopsy diagnoses were identical in 43 cases. The accuracy rate of biopsy distinguishing malignant from benign lesions was 99.1%, and the rate for determining tumor histological type (excluding the nondiagnostic biopsies) was 95.1%. The sensitivity and specificity in detecting malignancy were 98.9% and 100%, respectively.In several situations, there is still a role for biopsy before intervention. Percutaneous needle core biopsy under ultrasonography guidance is highly accurate and safe, and can determine the proper management of undefinable masses.

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Section: Discussionmentioning

confidence: 99%

Accuracy and safety of ultrasound-guided percutaneous needle core biopsy of renal masses

Wang¹,

et al. 2018

Medicine

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“…Facilitators and Barriers: Seventy-one percent of papers found that particularly age, comorbidities, BMI and gender influenced treatment decision-making representing the factors as either a barrier and/or facilitator based on how they were presented in the paper 12-16, 18, 21, 23, 24, 26-31, 33-47 . Of those, five papers highlighted that younger patients were identified as more likely to undergo partial nephrectomy (PN) or nephron sparring surgery (NSS) (including, laparoscopic partial nephrectomy (LPN), or robotic partial nephrectomy (RPN)) 24,29,34,43,46 , whereas those undergoing ablation or AS were older with more comorbidities 15,24,29,34,35,[43][44][45][46] .…”

Section: Patient Demographic Factorsmentioning

confidence: 99%

The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

et al. 2021

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Introduction: With a growing number of treatment options for localised kidney cancer, patients and health care professionals have both the opportunity and the burden of selecting the most suitable management option. This mixed method systematic review aims to understand the barriers and facilitators of the treatment decision-making process in localised kidney cancer. Methods: We searched PubMed, Embase, and Cochrane Central databases between 1st of January 2004 and 23rd of April 2020 using the JBI Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We identified 553 unique citations, of these 511 were excluded resulting in 42 articles included for synthesis. The Purpose, Respondents, Explanation, Findings and Significance and the Strengthening the Reporting of Observational Studies in Epidemiology checklist were applied. Results: The key themes describing barriers and facilitators to treatment decisionmaking were identified and categorised into three domains: (1) kidney cancer specific characteristics; (2) decision-maker related criteria; and (3) contextual factors.The main facilitators identified within these domains were: size at diagnosis, age, comorbidities, BMI, gender, nephrometry scoring systems, biopsy, socio-economic status, family history of cancer, year of diagnosis, geographic region and practice pattern. The key barriers were race, gender, patient anxiety, low confidence in diagnostic and treatment options, cost of procedure and practice patterns.

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“…The diagnostic performance of PHD3 was improved when considering only those patients with tumor size >2 cm. An active surveillance cohort study reported no association between a tumor size <2 cm and delayed intervention [12]. We suggest that measurement of the PHD3 level will yield superior diagnostic accuracy in significant RCC.…”

Section: Discussionmentioning

confidence: 72%

Prolyl hydroxylase-3 is a novel renal cell carcinoma biomarker

et al. 2019

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PurposeThe aim of this study was to determine the suitability of serum prolyl hydroxylase-3 (PHD3) as a diagnostic or monitoring biomarker of renal cell carcinoma (RCC).Materials and MethodsBetween October 2013 and March 2015, we prospectively recruited study participants. The RCC group consisted of 56 patients who underwent radical or partial nephrectomy. The control group included 56 healthy kidney donors and 13 patients with benign renal masses. Blood from the RCC patients was sampled prior to surgery and again 1 and 3 months after the operation. Serum PHD3 levels were measured via enzyme-linked immunosorbent assay and compared between RCC patients and controls.ResultsRCC patients had higher serum PHD3 levels than controls (0.79±0.17 ng/mL vs. 0.73±0.09 ng/mL, p=0.023), with an area under curve (AUC) of 0.668. With a cutoff value of 0.761 ng/ml, the sensitivity, specificity, positive predictive value, and negative predictive value were 66.1%, 68.1%, 28.8%, and 37.3%, respectively. No significant difference in PHD3 level was observed between healthy kidney donors and patients with benign renal masses. The predictive performance of PHD3 was improved in subgroup analyses of RCC patients with a tumor size >2 cm (n=40) or clear-cell histology (n=44), with AUCs of 0.709 and 0.688, respectively. Among 37 patients with PHD3 levels greater than the cutoff value of 0.761 ng/mL, the postoperative PHD3 levels at 1 and 3 months were significantly lower than the preoperative PHD3 levels (both p<0.001).ConclusionsSerum PHD3 represents a novel RCC biomarker that shows acceptable diagnostic performance.

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Predictors of Delayed Intervention for Patients on Active Surveillance for Small Renal Masses: Does Renal Mass Biopsy Influence Our Decision?

Cited by 26 publications

References 25 publications

Accuracy and safety of ultrasound-guided percutaneous needle core biopsy of renal masses

Accuracy and safety of ultrasound-guided percutaneous needle core biopsy of renal masses

The Current Evidence for Factors that Influence Treatment Decision Making in Localized Kidney Cancer: A Mixed Methods Systematic Review

Prolyl hydroxylase-3 is a novel renal cell carcinoma biomarker

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