MP67-20 IDENTIFYING BARRIERS TO THE ADOPTION OF PERCUTANEOUS RENAL TUMOUR BIOPSY IN THE MANAGEMENT OF SMALL RENAL MASSES

Introduction: Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decisionmaking. However, many urologists are reluctant to use RTB as a standard of care. This study characterizes the current use of RTB in the management of SRMs and identifies barriers to a more widespread adoption.Methods: A web-based survey was sent to members of the Canadian and Quebec Urological Associations who had registered email address (n=767) in June 2016. The survey examined physicians’ practice patterns, RTB use, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents.Results: The response rate was 29% (n=223), of which 188 respondents were eligible. A minority of respondents (12%) perform RTB in >75% of cases, while 53% never perform or perform RTB in <25% of cases. Respondents with urological oncology fellowship training were more likely to request a biopsy than their colleagues without such training. The most frequent management-related reason for not using routine RTB was a belief that biopsy won’t alter management, while the most frequent pathology-related reason was the risk of obtaining a false-negative or a non-diagnostic biopsy.Conclusions: Adoption of RTBs remains low in Canada. Concerns about the accuracy of RTB and its ability to change clinical practice are the largest barriers to adoption. A knowledge translation strategy is needed to address these concerns. Future studies are also required in order to define where RTB is most valuable and how to best to implement it.

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Ablative technologies for renal cancer

10.1093/med/9780199659579.003.0087 ◽

2017 ◽

Author(s):

Stephen Faddegon ◽

Ephrem O. Olweny ◽

Jeffrey A. Cadeddu

Keyword(s):

Clinical Stage ◽

Renal Tumour ◽

Small Renal Masses ◽

Renal Masses ◽

Ongoing Research ◽

Novel Technologies ◽

American Urological Association ◽

Stage 1 ◽

Surgical Treatments ◽

Tumour Ablation

Nearly two-thirds of newly detected renal masses are clinical stage 1, with T1a tumours accounting for 60% of the newly detected stage 1 tumours. Guideline panels convened by the American Urological Association and the European Association of Urology recommend nephron-sparing surgery as the gold standard treatment for small renal masses, with active surveillance and thermal ablation recommended as alternative strategies in select patients. However, there is a dearth of studies directly comparing outcomes for energy-based ablation to those for traditional surgical treatments for small renal masses, and future prospective randomized trials will be invaluable in this regard. Ongoing research in renal tumour ablation targets several areas, including but not limited to achieving larger ablation sizes, decreasing morbidity, and development of novel technologies for renal tumour ablation.

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MP40-02 INCREASED UPTAKE OF RENAL TUMOUR BIOPSIES FOR SMALL RENAL MASSES – RESULTS OF A MULTICENTRE CANADIAN EXPERIENCE

The Journal of Urology ◽

10.1016/j.juro.2014.02.1337 ◽

2014 ◽

Vol 191 (4S) ◽

Author(s):

Jaimin R. Bhatt ◽

Simon Tanguay ◽

Zhihui Liu ◽

Patrick O. Richard ◽

Anil Kapoor ◽

...

Keyword(s):

Renal Tumour ◽

Small Renal Masses ◽

Renal Masses ◽

Canadian Experience

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Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205655 ◽

2019 ◽

Vol 72 (5) ◽

pp. 363-367

Author(s):

Susan Prendeville ◽

Patrick O Richard ◽

Michael A S Jewett ◽

John R Kachura ◽

Joan M Sweet ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Papillary Renal Cell Carcinoma ◽

Renal Tumour ◽

Renal Masses ◽

Molecular Features ◽

Tumour Biopsy

AimsRenal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.MethodsThis single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).ResultsWe observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.ConclusionThere was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.

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