Utilization of renal mass biopsy in patients with localized renal cell carcinoma: A population-based study utilizing the National Cancer Database.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 662-662
Author(s):  
Devin Patel ◽  
Fady Ghali ◽  
Sunil Patel ◽  
Nathan Miller ◽  
Aaron Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Logistic Regression ◽  
Cell Carcinoma ◽  
Tumor Size ◽  
Renal Cell ◽  
Renal Mass ◽  
Temporal Trends ◽  
National Cancer Database ◽  
Multivariable Logistic Regression ◽  
Renal Mass Biopsy

662 Background: Recent guidelines suggest an increasing role for renal mass biopsy (RMB) in the management of renal cell carcinoma (RCC) prior to ablative therapy and in patients in whom active surveillance (AS) is being considered. Methods: We queried the National Cancer Database for cases of localized (cT1-cT3N0M0) RCC between 2004-2015. Unadjusted temporal trends in receipt of RMB were characterized over the study period based on type of treatment [partial nephrectomy (PN), radical nephrectomy (RN), ablation, and surveillance], tumor size, age and Charlson Comorbidity Index and compared using analysis of variance. Multivariable logistic regression was used to test for the association between patient, tumor and treatment variables and use of RMB. Results: 338,252 patients were analyzed, with 11.9% (40,276) undergoing RMB. Use of RMB increased from 1,586 (7.6%) in 2004 to 5,629 (16.2%) in 2015 (p<0.001). On treatment strategy, use of RMB increased the greatest in association with ablation from 27% to 63% across the study period (p<0.001). On tumor size, use of RMB increased the greatest for tumors 2-4 cm from 9% to 20% (p<0.001). Conversely, utilization of RMB increased proportionally across different age (p=0.17) and comorbidity (p=0.18) groups over time. Multivariable logistic regression revealed that year of diagnosis (OR 1.06; p<0.001), black race (OR 1.04; p=0.02), higher education (OR 1.09; p<0.001) and insured status (OR 1.23; p<0.001) were associated with increased RMB. However, increasing age (p=0.23) and comorbidity (p=0.35) were not. Compared to tumors <2 cm in size, tumors 2-4 cm (OR 1.36; p<0.001), 4-7 cm (OR 1.18; p<0.001) and >7 cm (OR 1.05; p=0.03) were associated with higher RMB. Compared to treatment with RN, treatment with PN was not associated with increased RMB (p=0.92); however, treatment with ablation (OR 10.90; p<0.001) and with surveillance (OR 4.83; p<0.001) were. Conclusions: The largest increase in RMB was associated with ablation treatment. Rates of RMB for tumors <2 cm and for older, sicker patients not undergoing treatment have correspondingly increased less, indicating RMB may not be as highly used for surveillance.

Histologic Heterogeneity of Extirpated Renal Cell Carcinoma Specimens: Implications for Renal Mass Biopsy

2020 ◽  
Vol 7 (3) ◽  
pp. 20-25
Author(s):  
Lauren Nahouraii ◽  
Jordan Allen ◽  
Suzanne Merrill ◽  
Erik Lehman ◽  
Matthew Kaag ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Tumor Stage ◽  
High Grade ◽  
Renal Masses ◽  
Histologic Heterogeneity ◽  
Adequate Sampling ◽  
Renal Mass Biopsy

Pathologic characteristics of extirpated renal cell carcinoma (RCC) specimens <7  cm were reviewed to get better information on technical nuances of renal mass biopsy (RMB). Specimens were stratified according to tumor stage, nuclear grade, size, histology, presence of lymphovas-cular invasion (LVI), necrosis, and sarcomatoid features. When considering pT1 (0–7 cm) tumors pT1b (4–7 cm), RCC masses were more likely to have necrosis (43% vs 16%, P < 0.001), LVI (6% vs 2%, P = 0.024), high-grade nuclear elements (29% vs 17%, P < 0.001), and sarcomatoid features (2% vs 0%, P = 0.006) compared with pT1a (0–4 cm) tumors. Additionally, pT3a tumors were more highly associated with necrosis (P = 0.005), LVI, sarcomatoid features, and high-grade disease (P for all < 0.001) when compared to pT1 masses. For masses <4 cm, pT3a cancers were more likely to demonstrate necrosis (38% vs 16%, P < 0.001), LVI (10% vs 2%, P = 0.037), high-grade nuclear elements (31% vs 17%, P = 0.05), and sarcomatoid features (3% vs 0%, P = 0.065) compared to pT1a tumors. Similarly, for masses 4–7 cm, pathologic T3a tumors were significantly more likely to have sarcomatoid features (16% vs 2%, P < 0.001) and LVI (28% vs 6%, P < 0.001) compared to pT1b tumors. In summary, pT3a tumors and those RCC masses >4 cm exhibit considerable histologic heterogeneity and may harbor elements that are not easily appreciated with limited renal sampling. Therefore, if RMB is considered for renal masses greater than 4 cm or those that abut sinus fat, a multi-quadrant biopsy approach is necessary to ensure adequate sampling and characterization of the mass.

Treating the Two Extremes in Renal Cell Carcinoma: Management of Small Renal Masses and Cytoreductive Nephrectomy in Metastatic Disease

2014 ◽  
pp. e214-e221 ◽  
Author(s):  
Dae Y. Kim ◽  
Christopher G. Wood ◽  
Jose A. Karam
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Cytoreductive Nephrectomy ◽  
Renal Cell Carcinomas ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Renal Mass Biopsy

OVERVIEW: The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.

MP50-09 UTILIZATION OF RENAL MASS BIOPSY IN PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA

2020 ◽  
Vol 203 ◽  
pp. e755
Author(s):  
Devin Patel* ◽  
Fady Ghali ◽  
Sunil Patel ◽  
Nathan Miller ◽  
Aaron Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Renal Mass Biopsy ◽  
Localized Renal Cell Carcinoma

scholarly journals Utilization of renal mass biopsy in patients with localized renal cell carcinoma

2020 ◽  
Vol 19 ◽  
pp. e745-e746
Author(s):  
D. Patel ◽  
F Ghali ◽  
S. Patel ◽  
N. Miller ◽  
A. Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Renal Mass Biopsy ◽  
Localized Renal Cell Carcinoma

Partial Nephrectomy For a Presumed Single Renal Mass Revealing Multiple Tumor Histologies: A Series of 4 Patients

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S61-S61
Author(s):  
S Arora ◽  
C G Rogers ◽  
K Arora ◽  
R Abou Shaar ◽  
B Kezlarian ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Renal Mass ◽  
Clear Cell ◽  
Papillary Renal Cell Carcinoma ◽  
Chromophobe Renal Cell Carcinoma ◽  
Cell Renal Cell Carcinoma ◽  
Renal Mass Biopsy

Abstract Introduction/Objective Renal mass biopsy is known to have a low but unavoidable diagnostic error rate. However, the occurrence of multiple adjacent masses mimicking one mass clinically has been minimally studied. Methods We report a series of four patients who were radiologically presumed to have a single renal mass and treated with partial nephrectomy, yet who were found to have multiple demarcated renal cell carcinoma histologies at pathologic evaluation. Results All were men aged 63–70 years. Grossly, tumors were red brown with scant, bright yellow foci in one of them. Dominant tumors followed by smaller tumors were: patient 1 - clear cell renal cell carcinoma (5.0 cm), clear cell papillary renal cell carcinoma (0.5 cm), and papillary adenoma (0.6 cm); patient 2 - clear cell renal cell carcinoma (1.5 cm) and clear cell papillary renal cell carcinoma (0.5 cm); patient 3 - papillary renal cell carcinoma (5.0 cm) and eosinophilic variant of chromophobe renal cell carcinoma (1.0 cm); patient 4 - chromophobe renal cell carcinoma (4.0 cm) and clear cell papillary renal cell carcinoma (0.6 cm). Immunohistochemical studies for cytokeratin 7, carbonic anhydrase IX, high molecular weight cytokeratin, CD10, and alpha-methyl acyl-CoA racemase (AMACR) confirmed the separate components in all. Conclusion This series adds to the spectrum of causes that may contribute to discordant results of renal mass biopsy and resection specimens. Secondary smaller tumors appear to be predominantly nonaggressive histologies, enriched for clear cell papillary renal cell carcinoma. Pathologists and urologists should be aware of this occurrence when considering the role of renal mass biopsy and interpreting the results.

The genomics of renal cell carcinoma and its role in renal mass biopsy

2018 ◽  
Vol 28 (4) ◽  
pp. 383-391
Author(s):  
Simpa S. Salami ◽  
Arvin K. George ◽  
Aaron M. Udager
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Renal Mass Biopsy

Does delay in time to surgery impact outcome in renal cell carcinoma: Analysis based on tumor size utilizing the National Cancer Database.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 664-664 ◽  
Author(s):  
Devin Patel ◽  
Fady Ghali ◽  
Margaret Meagher ◽  
Aaron Bradshaw ◽  
Sunil Patel ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Tumor Size ◽  
Renal Cell ◽  
Private Insurance ◽  
National Cancer Database ◽  
Time To Surgery ◽  
Surgery Delay ◽  
The Impact ◽  
Delay In Treatment

664 Background: The impact of delay in treatment for localized renal cell carcinoma (RCC) is controversial. We sought to determine the survival impact of time to definitive surgical treatment stratified by tumor size in a group of young, healthy patients from the National Cancer Database (NCDB). Methods: The NCDB was queried for cases of localized RCC (cT1-T3N0M0) in patients <60 years of age with Charlson comorbidity score of 0 from 2004-2015. Quartiles were formed from the range of time to surgery of the entire cohort in days, with delayed treatment as the fourth quartile. Tumors were stratified into size of <2 cm, 2-4 cm, 4-7 cm and >10 cm. Overall survival (OS) between early and delayed groups was calculated with Kaplan-Meier analysis (KMA) and multivariable cox proportional hazards (MVA) and stratified by tumor size. Logistic regression was performed to determine factors associated with delay in surgical care. Results: 44,149 patients were analyzed. Median time to treatment was 35 days (IQR 19-61). Early (n = 33,144) and delayed (>61 days, n =11,005) groups had a mean follow-up of 61.5 and 57.5 months, respectively (p < 0.001). KMA showed worse 5-yr OS in patients with surgery delay versus no delay for tumors 2-4 cm in size (5-yr OS 49% vs. 54%; p<0.001), 4-7 cm (5-yr OS 47% vs. 53%; p<0.001), >7 cm (5-yr OS 45% vs. 49%;p=0.0002), but not for tumors <2 cm (5 yr OS 49% vs. 51%: p=0.5848). MVA showed worse OS with surgery delay compared to no surgery delay in patients with tumor size 2-4 cm (HR 1.24; 95%CI 1.09-1.42), 4-7 cm (HR 1.32; 95%CI 1.16- 1.50) and >7 cm (HR 1.14; 95%CI 1.01-1.30) but not tumors <2 cm (HR 0.83; 95% CI 0.65-1.05). Delay in treatment was higher with older age (OR 1.01; p<0.001), male gender (1.11; p<0.001), non-private insurance (OR 1.44; p<0.001), black race (OR 1.60; p<0.001), decreased education (OR 1.11; p<0.001) and tumors >2 cm (OR 1.23; p<0.001). Conclusions: In patients <60 years of age and CCI of 0, delay in treatment was associated with worse OS for tumors >2 cm but not for RCC <2 cm in size. While these findings support data suggesting that active surveillance for RCC < 2 cm in size is appropriate even in young and healthy patients, caution should be exercised in patients with tumors > 2 cm.

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