Can Renal Mass Biopsy Improve Outcomes? Impact on Clinical Decision-Making

2020 ◽  
pp. 13-30
Author(s):  
Brian T. Kadow ◽  
Jeffrey John Tomaszewski ◽  
Miki Haifler ◽  
Alexander Kutikov
Keyword(s):  
Decision Making ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Renal Mass Biopsy

Utilization and contemporary results of renal mass biopsy.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 623-623
Author(s):  
David Cahn ◽  
Caitlin Lim ◽  
Rosaleen Parsons ◽  
Benjamin T. Ristau ◽  
Alexander Kutikov ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Resection ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Performance Characteristics ◽  
Published Data ◽  
Renal Masses ◽  
Poor Grade ◽  
Renal Mass Biopsy

623 Background: Renal mass biopsy (RMB) for localized renal masses (RM) is being re-evaluated to improve risk stratification and minimize morbidity from over-treatment. We review our institutional experience with RMB to identify performance characteristics and highlight opportunities to improve management. Methods: Using our prospectively maintained database, we identified patients who underwent core RMB +/- fine needle aspiration (FNA). We describe performance characteristics and assess pathologic concordance. Using the University of Michigan (UM) algorithm, we reviewed the potential that RMB influenced therapeutic decision-making. Results: We noted 374 RMBs performed from 1999-2015 (66% within last 5 years). Core RMB (+/- FNA) was performed in 65.2% (244/374) of cases, of which 41% (99/244) underwent surgical resection. Initial core RMB was non-diagnostic in 9% (9/99) of surgical cases and subsequently diagnosed with RCC. RCC diagnosed on core RMB that underwent surgical resection demonstrated histologic and grade concordance of 94.3% and 62.5%. All discordant grades were upgraded at surgery. 11% of all RMB were benign and no surgical intervention occurred. In our cohort, 19% of all RMB patients treated surgically had tumors classified as favorable or intermediate < 2cm using the UM algorithm and might otherwise have been candidates for AS. Conversely, 42% of all surgically treated patients had UM favorable characteristics but had tumors > 4cm and therefore underwent surgical resection based on size criteria in the context of RMB results. Conclusions: RMB is effective in the evaluation of RM with minimal morbidity. Our histologic/grade concordance is consistent with published data and underscores that RMB harbors clinical uncertainties. Clinical management pathways incorporating RMB may decrease over-treatment but also may risk under-treatment based on poor grade concordance. Using the UM algorithm, 30% of lesions in our cohort were AS candidates after RMB (over-treatment risk). Conversely, 18% of surgically treated lesions were UM AS candidates after RMB and upgraded on final pathology, demonstrating the risk of under treatment. RMB may be considered in patients where results would influence clinical decision-making.

392 Role of MRI in indeterminate renal mass: Diagnostic accuracy and impact on clinical decision making

2014 ◽  
Vol 13 (1) ◽  
pp. e392
Author(s):  
T. Kwon ◽  
I.G. Jeong ◽  
D. You ◽  
B. Lim ◽  
K-S. Han ◽  
...  
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Histologic Diagnosis of Renal Mass Biopsy

2019 ◽  
Vol 143 (6) ◽  
pp. 705-710 ◽  
Author(s):  
Steven S. Shen ◽  
Jae Y. Ro
Keyword(s):  
Renal Mass ◽  
Clinical Decision Making ◽  
Wide Spectrum ◽  
Medical Center ◽  
Daily Practice ◽  
Clinical Decision ◽  
Histologic Diagnosis ◽  
Laboratory Procedure ◽  
Renal Masses ◽  
Renal Mass Biopsy

Context.— Core biopsy has been increasingly used for clinical decision-making in the management of patients with renal masses. The sensitivity and specificity of histologic diagnoses of renal mass biopsies depend on many factors such as adequate sampling and tissue processing, diagnostic skill and experience, and appropriate use of ancillary techniques. Objective.— To review the indications, emphasize the importance of obtaining adequate diagnostic material, and introduce a general diagnostic approach, in conjunction with immunohistochemistry, in diagnosis of renal mass biopsies. Data Sources.— Literature review and personal experiences in daily practice and consultation diagnosis of renal masses in a large tertiary medical center. Conclusions.— For renal mass biopsies, it is critical to obtain adequate diagnostic material and establish a standard laboratory procedure in working with small biopsy specimens. The key for the diagnosis is to be familiar with different tumor entities with characteristic morphology and to understand the wide spectrum of tumor heterogeneity. By developing a systematic approach, one can categorize the tumor and create a sensible differential diagnosis based on the growth pattern and cellular morphology. Immunohistochemistry is particularly helpful for renal mass biopsy diagnosis in selected situations.

Role of MRI in indeterminate renal mass: diagnostic accuracy and impact on clinical decision making

2015 ◽  
Vol 47 (4) ◽  
pp. 585-593 ◽  
Author(s):  
Taekmin Kwon ◽  
In Gab Jeong ◽  
Sangjun Yoo ◽  
JungBok Lee ◽  
Sungwoo Hong ◽  
...  
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision

MP40-19 ROLE OF MRI IN INDETERMINATE RENAL MASS: DIAGNOSTIC ACCURACY AND IMPACT ON CLINICAL DECISION MAKING

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Taekmin Kwon ◽  
In Gab Jeong ◽  
Dalsan You ◽  
Bumjin Lim ◽  
Donghyun Lee ◽  
...  
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Renal Mass ◽  
Clinical Decision Making ◽  
Clinical Decision

Clinical Decision Making and Oral Motor Treatments

ASHA Leader ◽  
2005 ◽  
Vol 10 (8) ◽  
pp. 8-35 ◽  
Author(s):  
Heather M. Clark
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Oral Motor

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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