AUA 2017: Identifying barriers to the adoption of percutaneous renal tumour biopsy in the management of small renal masses

Boston, MA (UroToday.com) Renal tumor biopsy (RTB) has been demonstrated to be a safe, feasible procedure without the risk of seeding that was concerning historically. As the authors note, up to 30% of small renal masses (SRMs) are benign, and of those that are malignant, many have low-metastatic potential. With a well-known history of being strong proponents for RTB prior to treatment, the authors initiated a survey to better assess RTB utilization in the management of SRMs and to identify the barriers to a more widespread adoption of RTB.

A survey contained questions regarding the physicians practice patterns, RTB utilization and potential barriers of RTB was sent to all 767 members of the Canadian Urological Association and the Quebec Urological Association, with 223 (29%) ultimately responding, including 10 residents/fellows. After excluding 35 due to incomplete responses, the remaining were divided as follows: 38 (20%) practiced in an academic center, 72 (38%) in a university-affiliated center and 78 (41%) in a community/rural hospital. 25% had training in urologic oncology.

Only a minority of responders (12%) requested RTB in >75% of cases while 53% never performed or performed RTB in less than 25% of cases. Physicians with urologic oncology fellowship-training were more likely to request a biopsy than endourologists (p=0.01) and physicians with no fellowship-training (p=0.003). Number of years in practice and volume of consults were not significant predictors.

The greatest management-related barrier was the perception that biopsy wouldn’t alter management (36%). On the other hand, the risk of obtaining a false-negative or a non-diagnostic biopsy was reported as the greatest pathology-related barrier to a more widespread adoption of RTB in the management of SRMs.

Ultimately, the authors states that RTB remains underutilized in Canada, and emphasize that education is needed to help improve its utilization. However, it should be noted that RTB is likely more utilized in Canada than in the United States. As such, if utilization is so low even in Canada, it is likely much lower amongst AUA members.

Limitations:
1. Survey sent to only Canadian Urologists and CUA/QUA members.

Presented by: Patrick Richard, MD

Co-Authors: Patrick O. Richard, Lisa Martin, Luke Lavallée, Phil Violette, Maria Komisarenko, Kunal Jain, Michael Jewett, Antonio Finelli

INSTITUTION(S): Multi-institutional, Canada

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA
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