Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer

Patel, Hiten D.; Nichols, Paige; Su, Zhuo; Gupta, Mohit; Cheaib, Joseph G.; Allaf, Mohamad E.; Pierorazio, Phillip M.

doi:10.1016/j.urology.2019.08.043

Cited by 32 publications

(35 citation statements)

References 21 publications

(27 reference statements)

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“…RMB was associated with a significantly higher rate of benign pathology at intervention, with no patients with a benign RMB undergoing nephrectomy and almost all of these patients opting for observation. Patients with a malignant RMB were less frequently assigned to observation, in contrast to a prior report [15] . It is frequently argued by opponents that RMB rarely changes management, but our findings indicate that inclusion of RMB in an assessment algorithm could avoid unnecessary intervention and better select patients for treatment.…”

Section: Discussionmentioning

confidence: 87%

“…In the context of prior rates reported in multiple academic series [11] , [12] and systematic reviews [2] , [13] , [14] , this rate may appear to be surprisingly low. Previous analysis of the National Cancer Data Base (NCDB) and Surveillance, Epidemiology and End Results (SEER) database reported RMB utilization rates of 15.3–30.1% [15] , [16] . However, a major limitation of the NCDB reporting is that it only includes patients with known malignancy.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative

Patel

Lane

Chintalapati

et al. 2021

European Urology Open Science

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Background Renal mass biopsy (RMB) has had limited and varied utilization to guide management of renal masses (RM). Objective To evaluate utilization of RMB for newly diagnosed cT1 RMs across diverse practice types and assess associations of outcomes with RMB. Design, setting, and participants MUSIC-KIDNEY commenced data collection in September 2017 for all newly presenting patients with a cT1 RM at 14 diverse practices. Patients were assessed at ≥120 d after initial evaluation. Outcome measurements and statistical analysis Demographics and outcomes were compared for patients undergoing RMB versus no RMB. Clinical and demographic characteristics were summarized by RMB status using a χ 2 test for categorical variables and Student t test for continuous variables. A mixed-effects logistic regression model was constructed to identify associations with RMB receipt. Results and limitations RMB was performed in 15.5% ( n = 282) of 1808 patients with a cT1 RM. Practice level rates varied from 0% to 100% ( p = 0.001), with only five of 14 practices using RMB in >20% of patients. On multivariate analysis, predictors of RMB included greater comorbidity (Charlson comorbidity index ≥2 vs 0: odds ratio [OR] 1.44; p = 0.025) and solid lesion type (cystic vs solid: OR 0.17; p = 0.001; indeterminate vs solid: OR 0.58; p = 0.01). RMB patients were less likely to have benign pathology at intervention (5.0% vs 13.5%; p = 0.01). No radical nephrectomies were performed for patients with benign histology at RMB. The limitations include short follow-up and inclusion of practices with low numbers of RMBs. Conclusions Utilization of RMB varied widely across practices. Factors associated with RMB include comorbidities and lesion type. Patients undergoing RMB were less likely to have benign histology at intervention. Patient summary Current use of biopsy for kidney tumors is low and varies across our collaborative. Biopsy was performed in patients with greater comorbidity (more additional medical conditions) and for solid kidney tumors. Pretreatment biopsy is associated with lower nonmalignant pathology detected at treatment.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative

Patel

Lane

Chintalapati

et al. 2021

European Urology Open Science

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“…In this context, a renal mass biopsy might be advocated as a useful tool to aid in the selection of the most appropriate management strategy [20]. Recent data show that there has been an increase in the use of renal mass biopsy over the past decade, and this is associated with the "nonsurgical" management of SRMs [21]. However, in most high-volume centers, this diagnostic tool is used on a utilitarian basis (when it might change management) [1,2], and this was the case also for most of the centers participating in the present study.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted Partial Nephrectomy for “Very Small” (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort

Carbonara

Simone

Minervini

et al. 2021

European Urology Focus

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“…8 ). The use of percutaneous image-guided renal biopsies could also reduce the number of nephrectomies performed for benign renal masses and for indolent renal carcinomas [ 12 , 48 , 49 ]. The pre-operative diagnosis of an indolent RCC could enable the clinical team to adopt a more conservative approach such as active surveillance, especially in older or frail patients.…”

Section: Percutaneous Complicationsmentioning

confidence: 99%

“…The use of nephron-sparing interventions such as partial nephrectomy and ablative techniques is also increasingly favoured over radical nephrectomies. An analysis of the National Cancer Database, recognised as the largest cancer registry in the world, showed that the proportion of patients receiving partial nephrectomy has almost doubled over approximately 10 years, from approximately 36.4% in 2004 to 61.2% in 2015 [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Complications of renal interventions: a pictorial review of CT findings

2021

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A number of potential vascular and non-vascular complications can arise from surgical, extracorporeal shock wave lithotripsy, radiotherapy and radiological renal interventions, including percutaneous image-guided biopsy and drainage. Computed tomography scan is usually one of the first and most important diagnostic imaging examinations requested when a potential complication is suspected. There are a wide range of common and uncommon potential complications from renal interventions. An understanding of underlying risk factors is important to reduce potential complications from renal intervention. Radiologists play a crucial role in recognising and diagnosing post-renal intervention complications on computed tomography scans, which could significantly improve the patient’s prognosis.

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Renal Mass Biopsy is Associated with Reduction in Surgery for Early-Stage Kidney Cancer

Cited by 32 publications

References 21 publications

Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative

Utilization of Renal Mass Biopsy for T1 Renal Lesions across Michigan: Results from MUSIC-KIDNEY, A Statewide Quality Improvement Collaborative

Robotic-assisted Partial Nephrectomy for “Very Small” (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort

Complications of renal interventions: a pictorial review of CT findings

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