Does renal mass biopsy influence multidisciplinary treatment recommendations?

Abstract

Purpose: To examine how a multidisciplinary team approach incorporating renal mass biopsy (RMB) into decision making changes the management strategy.

Methods: A multidisciplinary team comprised of a radiology proceduralist, a pathologist and urologists convened monthly for renal mass conference with a structured presentation of patient demographics, co-mborbidities, tumor pathology, laboratory and radiographic features. Biopsy protocol was standardized to an 18-gauge core needle biopsy using a sheathed apparatus under renal ultrasound guidance. Biopsy diagnostic rate, and concordance with nephrectomy specimens were summarized. Descriptive statistics were used to evaluate influence of RMB on management decisions.

Results: A total of 83 patients with a ≤4 cm mass were discussed, and 66% of patients underwent RMB. Of those, 87% were diagnostic with 9% of core biopsies showing benign pathology. Active surveillance (AS) was recommended for 34% of patients with biopsy data as compared to 64% of those without biopsy. Ablation was recommended for 38% of the biopsy cohort compared to 7% without biopsy. Partial nephrectomy rates were similar for both cohorts, approximately 17% and 22%, respectively. Our complication rate was 1.5%, with only 1 Clavien-Dindo Grade 2 complication. Histology was concordant in 93% of patients that ultimately underwent partial nephrectomy after biopsy.

Conclusions: Over half of our SRM patients underwent a RMB that provided a diagnosis in 85% of cases. RMB aided in shared decision making by providing insight into the biology of renal masses, which helps to guide multidisciplinary management and consideration of nephron sparing options.

Keywords:

• Renal mass biopsy
• small renal mass
• renal biopsy
• active surveillance
• renal cell carcinoma

Compliance with ethical standards

The database used in this research was sanctioned by the University of Virginia Institutional Review Board.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Authors contribution

JM Lobo: protocol/project development, data analysis, manuscript writing/editing; MB Clements: data analysis, manuscript writing/editing, data collection or management; DP Bitner: data collection or management, manuscript writing/editing; SW Noona: data collection or management, manuscript writing/editing; MI Sultan: data collection or management; MD Mikula: data collection or management, manuscript writing/editing; HP Cathro: data collection or management, manuscript writing/editing; DL Lambert: data collection or management, manuscript writing/editing; NS Schenkman: protocol/project development, manuscript writing/editing; TL Krupski: protocol/project development, data analysis, manuscript writing/editing.

Disclosure statement

The authors declare they have no conflicts of interest to report.

Additional information

Funding

This research was supported by resources within the Cancer Control and Population Health program at the University of Virginia Cancer Center.