Identifying the use and barriers to the adoption of 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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MP67-20 IDENTIFYING BARRIERS TO THE ADOPTION OF PERCUTANEOUS RENAL TUMOUR BIOPSY IN THE MANAGEMENT OF SMALL RENAL MASSES

The Journal of Urology ◽

10.1016/j.juro.2017.02.2056 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Patrick O. Richard ◽

Lisa Martin ◽

Luke Lavallée ◽

Phil Violette ◽

Maria Komisarenko ◽

...

Keyword(s):

Renal Tumour ◽

Small Renal Masses ◽

Renal Masses ◽

Tumour Biopsy

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Renal Tumour Biopsy – A New Standard of Care?

European Urology ◽

10.1016/j.eururo.2015.09.017 ◽

2016 ◽

Vol 69 (4) ◽

pp. 674-675 ◽

Cited By ~ 1

Author(s):

Roger Kockelbergh ◽

Leyshon Griffiths

Keyword(s):

Standard Of Care ◽

Renal Tumour ◽

Tumour Biopsy

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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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Standard of Care for Small Renal Masses in the 21st Century

JAMA Surgery ◽

10.1001/jamasurg.2015.0440 ◽

2015 ◽

Vol 150 (7) ◽

pp. 672 ◽

Cited By ~ 4

Author(s):

Joshua J. Meeks ◽

Chris M. Gonzalez

Keyword(s):

21St Century ◽

Standard Of Care ◽

Small Renal Masses ◽

Renal Masses

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Evaluation of Hemostatic Aids in Laparoscopic Nephron-Sparing Surgery

The Scientific World JOURNAL ◽

10.1100/tsw.2011.7 ◽

2011 ◽

Vol 11 ◽

pp. 133-141

Author(s):

Saleh Binsaleh

Keyword(s):

Partial Nephrectomy ◽

Standard Of Care ◽

The Other ◽

Energy Sources ◽

Small Renal Masses ◽

Renal Masses ◽

Minimal Invasiveness ◽

Hemostatic Agents ◽

Nephron Sparing ◽

Laparoscopic Techniques

Partial nephrectomy is considered the standard of care for the management of small renal masses, and laparoscopic techniques are becoming popular for multiple reasons, one of which is minimal invasiveness. On the other hand, kidneys are extremely vascular organs, and renal hemorrhage is a major cause of morbidity after laparoscopic partial nephrectomies. Control of bleeding and management of calyceal injuries can be difficult and make the procedure technically challenging. This review looks at the various energy sources and hemostatic agents that are available to reduce bleeding during laparoscopic partial nephrectomies.

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Review of the efficacy and safety of cryoablation for the treatment of small renal masses

Canadian Urological Association Journal ◽

10.5489/cuaj.193 ◽

2013 ◽

Vol 7 (1-2) ◽

pp. 38 ◽

Cited By ~ 8

Author(s):

Anil Kapoor ◽

Naji J. Touma ◽

Regina El Dib

Keyword(s):

Treatment Algorithm ◽

Case Series ◽

Cancer Control ◽

Standard Of Care ◽

Cochrane Library ◽

Success Rates ◽

Small Renal Masses ◽

Renal Masses ◽

Perinephric Hematoma ◽

Ablative Techniques

Purpose: Small renal masses are increasingly being discovered incidentally on imaging for another reason. The standard of care of these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques, such as radiofrequency ablation (RFA) and cryoablation, have taken a more prominent role in the treatment algorithm of these masses. We evaluate the effectiveness and safety of cryoablation to treat renal tumours.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: the Cochrane Library, PUBMED, EMBASE and LILACS.Results: There was no clinical trial identified in the literature. Thus, we described the results from 23 case series and retrospective studies with a reasonable sample size (number of reported patients in each study ≥30), with a total of 2104 analyzed tumours from 2038 patients. There was wide variability in the outcomes reported, but success rates were generally good. Follow-up was generally short, but some series reported outcomes at 5 years. The most common complications reported were hemorrhage (some of the patients requiring transfusion), perinephric hematoma and urine leaks.Conclusion: Cryoablation presents a feasible treatment for patients with small renal masses. Only short-term data are available and, assuch, meaningful conclusions regarding long-term cancer control cannot be made. More rigorous studies are needed.

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