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Perspectives on the Role of Biopsy for Management of T1 Renal Masses: Survey Results From Two Regional Quality Improvement Collaboratives

Published:February 06, 2022DOI:https://doi.org/10.1016/j.urology.2022.01.038

      Abstract

      Objective

      To understand perspectives on renal mass biopsy, a survey was distributed to urologists in the Michigan Urological Surgery Improvement Collaborative and Pennsylvania Urologic Regional Collaborative. Renal mass biopsy (RMB) may reduce treatment of benign renal neoplasms; however, utilization varies widely.

      Materials and Methods

      Michigan Urological Surgery Improvement Collaborative and Pennsylvania Urologic Regional Collaborative are two quality improvement collaboratives that include a “real-world” collection of urologists from academic- and community-based settings. A 12-item survey assessing current RMB utilization, patient- and tumor-specific factors, adverse events, impact on management, and simulated patient scenarios was distributed. Responses are reported using descriptive statistics.

      Results

      Many responders (n = 54) indicated using RMB in less than 25% of cT1a (59%) and cT1b (85%) tumors. The most important patient-specific factors on the decision to recommend RMB were possible metastasis to the kidney (94%), patient comorbidity as a risk factor for active treatment (89%), and patient age (81%). The most important tumor-specific factors were the presence of bilateral tumors (81%), tumor size (70%) and perceived potential of performing nephron-sparing surgery (67%). Ten responders (19%) noted barriers to RMB in their practice, 23 (43%) recalled experiences with complications or poor outcomes, and 43 (80%) reported experiences where the results of RMB altered management. When presented with simulated patients, few urologists (9%-20%) recommended RMB in younger patients with any sized mass. Recommendations varied based on patient age, comorbidity, and tumor size.

      Conclusion

      Understanding perspectives on RMB usage is essential prior to implementing quality improvement efforts. Most urologists participating in two statewide collaboratives infrequently recommend RMB. Optimizing RMB utilization may help reduce unnecessary treatments.
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      References

        • Sung H
        • Ferlay J
        • Siegel RL
        • et al.
        Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2021; 71: 209-249
        • Chandrasekar T
        • Boorjian SA
        • Capitanio U
        • et al.
        Collaborative review: factors influencing treatment decisions for patients with a localized solid renal mass.
        Eur Urol. 2021; 80: 575-588
        • Doolittle J
        • Piotrowski J
        • Zuk K
        • et al.
        Evolving trends for selected treatments of T1a renal cell carcinoma.
        Urology. 2019; 132: 136-142
        • Bauman TM
        • Potretzke AM
        • Wright AJ
        • et al.
        Partial nephrectomy for presumed renal-cell carcinoma: incidence, predictors, and perioperative outcomes of benign lesions.
        J Endourol. 2017; 31: 412-417
        • Frank I
        • Blute ML
        • Cheville JC
        • et al.
        Solid renal tumors: an analysis of pathological features related to tumor size.
        J Urol. 2003; 170: 2217-2220
        • Moskowitz D
        • Chang J
        • Ziogas A
        • et al.
        Treatment for T1a renal cancer substratified by size: "Less is More".
        J Urol. 2016; 196: 1000-1007
        • Campbell SC
        • Uzzo RG
        • Karam JA
        • et al.
        Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA Guideline: Part II.
        J Urol. 2021; 206: 209-218
        • Palumbo C
        • Mistretta FA
        • Knipper S
        • et al.
        Assessment of local tumor ablation and non-interventional management versus partial nephrectomy in T1a renal cell carcinoma.
        Minerva Urol Nefrol. 2020; 72: 350-359
        • Xing M
        • Kokabi N
        • Zhang D
        • et al.
        Comparative effectiveness of thermal ablation, surgical resection, and active surveillance for T1a renal cell carcinoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked Population Study.
        Radiology. 2018; 288: 81-90
        • Maurice MJ
        • Zhu H
        • Kiechle JE
        • et al.
        Nonclinical factors predict selection of initial observation for renal cell carcinoma.
        Urology. 2015; 86: 892-899
        • Yang G
        • Villalta JD
        • Meng MV
        • et al.
        Evolving practice patterns for the management of small renal masses in the USA.
        BJU Int. 2012; 110: 1156-1161
        • Patel HD
        • Nichols PE
        • Su ZT
        • et al.
        Renal mass biopsy is associated with reduction in surgery for early-stage kidney cancer.
        Urology. 2020; 135: 76-81
        • Rahbar H
        • Bhayani S
        • Stifelman M
        • et al.
        Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy–could a biopsy have guided management?.
        J Urol. 2014; 192: 1337-1342
        • Dave CN
        • Seifman B
        • Chennamsetty A
        • et al.
        Office-based ultrasound-guided renal core biopsy is safe and efficacious in the management of small renal masses.
        Urology. 2017; 102: 26-30
        • Marconi L
        • Dabestani S
        • Lam TB
        • et al.
        Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy.
        Eur Urol. 2016; 69: 660-673
        • Ozambela Jr., M
        • Wang Y
        • Leow JJ
        • et al.
        Contemporary trends in percutaneous renal mass biopsy utilization in the United States.
        Urol Oncol. 2020; 38: 835-843
        • Kutikov A
        • Smaldone MC
        • Uzzo RG
        • et al.
        Renal mass biopsy: always, sometimes, or never?.
        Eur Urol. 2016; 70: 403-406
        • Patel DN
        • Ghali F
        • Meagher MF
        • et al.
        Utilization of renal mass biopsy in patients with localized renal cell carcinoma: a population-based study utilizing the National Cancer Database.
        Urol Oncol. 2021; 39 (79 e71-79 e78)
        • McClure T
        • Sedrakyan A
        • LaRussa S
        • et al.
        Underutilization of renal mass biopsy: surveillance using the medicare database between 2004 and 2016.
        J Vasc Interv Radiol. 2020; 31: 854-857
        • Montie JE
        • Linsell SM
        • Miller DC
        Quality of care in urology and the Michigan urological surgery improvement collaborative.
        Urol Pract. 2014; 1: 74-78
        • Noyes SL
        • Kim T
        • Johnson A
        • et al.
        Quality of care for renal masses: the Michigan Urological Surgery Improvement Collaborative - kidney mass: identifying & defining necessary evaluation & therapy (MUSIC-KIDNEY).
        Urol Pract. 2020; 7: 507-514
        • von Elm E
        • Altman DG
        • Egger M
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4: e296
        • Patel AK
        • Rogers CG
        • Johnson A
        • et al.
        Initial observation of a large proportion of patients presenting with clinical stage T1 renal masses: results from the MUSIC-KIDNEY Statewide Collaborative.
        Eur Urol Open Sci. 2021; 23: 13-19
        • Patel RM
        • Safiullah S
        • Okhunov Z
        • et al.
        Pretreatment diagnosis of the small renal mass: status of renal biopsy in the United States of America.
        J Endourol. 2018; 32: 884-890
        • Leppert JT
        • Hanley J
        • Wagner TH
        • et al.
        Utilization of renal mass biopsy in patients with renal cell carcinoma.
        Urology. 2014; 83: 774-779
        • Shahait M
        • Jackman S
        • Landman J
        • et al.
        Utilization and operative influence of renal mass biopsy in the small renal mass: analysis from the Clinical Research Office of the Endourological Society Small Renal Mass registry.
        J Endourol. 2020; 34: 99-106
        • Prince J
        • Bultman E
        • Hinshaw L
        • et al.
        Patient and tumor characteristics can predict nondiagnostic renal mass biopsy findings.
        J Urol. 2015; 193: 1899-1904
        • Martini A
        • Larcher A
        • Bravi CA
        • et al.
        How to select the optimal candidates for renal mass biopsy.
        Eur Urol Oncol. 2021; 4: 506-509
        • Posielski NM
        • Bui A
        • Wells SA
        • et al.
        Risk factors for complications and nondiagnostic results following 1,155 consecutive percutaneous core renal mass biopsies.
        J Urol. 2019; 201: 1080-1087
        • Cher ML
        • Dhir A
        • Auffenberg GB
        • et al.
        Appropriateness criteria for active surveillance of prostate cancer.
        J Urol. 2017; 197: 67-74