Utilization and contemporary results of 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.

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

Renal Mass Biopsy ◽

10.1007/978-3-030-36036-8_2 ◽

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

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Histologic Diagnosis of Renal Mass Biopsy

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0272-ra ◽

2019 ◽

Vol 143 (6) ◽

pp. 705-710 ◽

Cited By ~ 1

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.

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Variation in LOD Across SARS-CoV-2 Assay Systems: Need for Standardization

Laboratory Medicine ◽

10.1093/labmed/lmaa103 ◽

2020 ◽

Author(s):

Youvraj Sohni

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Limit Of Detection ◽

Clinical Decision ◽

International Standards ◽

Performance Characteristics ◽

Clinical Testing ◽

Factors Affecting ◽

Diagnostic Assays ◽

Technology Platforms

Abstract Multiple SARS-CoV-2 emergency use authorization (EUA) tests are being used for clinical testing across various clinical testing laboratories for meeting the diagnostic challenges of the ongoing pandemic. However, cross-assay variations in performance characteristics need to be recognized. A better understanding is needed of the clinical implications of cross-assay variation in performance characteristics, particularly in the limit of detection (LOD) of the SARS-CoV-2 assays used for clinical testing. Herein, a snapshot of the diversity of SARS-CoV-2 EUA analytical assay systems including methodologies, assay designs, and technology platforms is presented. Factors affecting the variations in LOD are discussed. Potential measures that may standardize across the various assay systems are suggested. Development of international standards and reference materials for the establishment of performance characteristics may substantially alleviate potential clinical decision-making challenges. Finally, cross-assay variation in LODs among the diverse SARS-CoV-2 diagnostic assays impacts clinical decision-making with multiple assay systems in use and lack of standardization across platforms. International standards in parallel with continued cross-platform studies and collaborative efforts across pertinent healthcare entities will help mitigate some of the clinical decision-making challenges.

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Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic

Urology ◽

10.1016/j.urology.2020.09.010 ◽

2021 ◽

Vol 147 ◽

pp. 50-56

Author(s):

Kevin B. Ginsburg ◽

Gannon L. Curtis ◽

Devin N. Patel ◽

Wen Min Chen ◽

Marshall C. Strother ◽

...

Keyword(s):

Decision Making ◽

Overall Survival ◽

Clinical Decision Making ◽

Clinical Decision ◽

Renal Masses ◽

Surgical Delay

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

European Urology Supplements ◽

10.1016/s1569-9056(14)60387-0 ◽

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

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A review of COVID-19 therapeutics in pregnancy and lactation

Obstetric Medicine ◽

10.1177/1753495x211056211 ◽

2022 ◽

pp. 1753495X2110562

Author(s):

Sarah CJ Jorgensen ◽

Najla Tabbara ◽

Lisa Burry

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Elevated Risk ◽

Published Data ◽

Safety And Efficacy ◽

Pregnancy And Lactation ◽

Safety Signals ◽

In Pregnancy

Pregnant people have an elevated risk of severe COVID-19-related complications compared to their non-pregnant counterparts, underscoring the need for safe and effective therapies. In this review, we summarize published data on COVID-19 therapeutics in pregnancy and lactation to help inform clinical decision-making about their use in this population. Although no serious safety signals have been raised for many agents, data clearly have serious limitations and there are many important knowledge gaps about the safety and efficacy of key therapeutics used for COVID-19. Moving forward, diligent follow-up and documentation of outcomes in pregnant people treated with these agents will be essential to advance our understanding. Greater regulatory push and incentives are needed to ensure studies to obtain pregnancy data are expedited.

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