TY  - EJOU
AU  - Michel, Joaquin 
AU  - Lenis, Andrew T. 
AU  - Lec, Patrick M. 
AU  - Golla, Vishnukam 
AU  - Johnson, David C. 
AU  - Gollapudi, Kiran 
AU  - Blumberg, Jeremy 
AU  - Shuch, Brian M. 
AU  - Chamie, Karim 

TI  - Analysis of guideline recommended use of renal mass biopsy and association with treatment
T2  - Canadian Journal of Urology

PY  - 2020
VL  - 27
IS  - 4
SN  - 1488-5581

AB  - <b>Introduction:</b> 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).<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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).<br/>
<b>Conclusions:</b> 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.
KW  - renal mass
KW  -  renal cell carcinoma
KW  -  renal mass biopsy
KW  -  guidelines

DO  -