Open Access

ARTICLE

Analysis of guideline recommended use of renal mass biopsy and association with treatment

Joaquin Michel¹, Andrew T. Lenis¹, Patrick M. Lec¹, Vishnukam Golla¹, David C. Johnson², Kiran Gollapudi³, Jeremy Blumberg³, Brian M. Shuch^1,4, Karim Chamie^1,4

1 Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
2 Department of Urology, University of North Carolina, Chapel Hill, North Carolina, USA
3 Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
4 Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California, USA
Address correspondence to Dr. Andrew T. Lenis, 300 Stein Plaza, Suite 348, Los Angeles, CA 90095 USA

Canadian Journal of Urology 2020, 27(4), 10285-10293.

Abstract

Introduction: Renal mass biopsy (RMB) may not be indicated when the results are unlikely to impact management, such as in young and/or healthy patients and in elderly and/or frail patients. We analyzed the utility of RMB in three patient cohorts stratified by age-adjusted Charlson comorbidity index score (ACCI).
Materials and methods: We identified patients with cT1a renal tumors in the National Cancer Database from 2004-2014. We combined age and Charlson-Deyo scores to identify young and/or healthy patients (“healthy-ACCI”), elderly and/or frail patients (“frail-ACCI”), and a reference cohort. We performed multivariable logistic regression to identify predictors of RMB and treatment. We evaluated the impact of RMB on management by analyzing the proportion of high-grade disease on final pathology as a surrogate for risk stratification.
Results: We identified 36,720 healthy-ACCI, 2,516 frail-ACCI, and 18,989 reference-ACCI patients. Healthy-ACCI patients were less likely to undergo RMB (7.5% versus 10.8%; p < 0.001), while frail-ACCI patients underwent RMB at similar rates (11.8% versus 10.8%; p = 0.14) compared with reference-ACCI patients. On multivariable logistic regression, in both healthy-ACCI and frail-ACCI patients, RMB was associated with decreased odds of surgical treatment and increased odds of ablation and surveillance (all p < 0.01). In the frail-ACCI patients, higher grade disease at surgery was identified in the RMB cohort (32.9% versus 23.5%, p = 0.05).
Conclusions: RMB is performed less frequently in healthy-ACCI patients compared with the reference cohort. RMB is associated with decreased odds of surgical treatment and increased odds of surveillance and ablation in all cohorts. In frail-ACCI patients who underwent surgery, RMB may provide additional risk stratification as these patients had lower rates of low-grade disease.

---

Keywords

---