Does renal mass biopsy influence multidisciplinary treatment recommendations?. (2nd January 2020)

• Record Type: Journal Article
• Authors: Lobo, Jennifer M.; Clements, Matthew B.; Bitner, Daniel P.; Mikula, Matthew D.; Noona, Sean W.; Sultan, Mark I.; Cathro, Helen P.; Lambert, Drew L.; Schenkman, Noah S.; Krupski, Tracey L.
• Is Part Of: Scandinavian journal of urology. Volume 54:Number 1(2020)
• Page Start: 27
• Page End: 32
• Publication Date: 2020-01-02
• Subjects: Renal mass biopsy -- small renal mass -- renal biopsy -- active surveillance -- renal cell carcinoma; Urology -- Periodicals; 616.6
• DOI: 10.1080/21681805.2019.1703805
• Languages: English
• ISSNs: 2168-1805

Abstract

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.