AUA 2019: Comprehensive Assessment of the Morbidity of Renal Mass Biopsy: Population-Based Assessment of Biopsy-Related Complications

Chicago, IL (UroToday.com) Increasing use of axial imaging has contributed to an increase in the diagnosis of renal masses. Current imaging studies cannot easily distinguish benign from malignant lesions and renal mass biopsy (RMB) offers histologic information. While RMB is increasingly used by not widely adopted. The aim of the study is to characterize rates of complications associated with RMB in a large, population-based sample. Associations between preoperative RMB and perioperative complications of renal surgery were assessed.

The authors performed a matched retrospective cohort study of patients who underwent RMB between 2003-2015 in Canada. Patients who underwent RMB were compared to matched sample cohorts from the general population. Patients who underwent partial nephrectomy were studied separate from those who underwent radical nephrectomy. Outcomes of interest included mortality, operative and non-operative interventions, hospitalizations and emergency room (ER) visits within 30 days of biopsy.

A total of 6840 patients who underwent RMB were evaluated. The authors found higher rates of mortality (RR 7.95, 95% CI 5-12.6), hospitalization (RR 10.40, 95% CI 2.94-3.80), and ER visits (RR 3.37, 95% CI 2.94-3.80) were higher in the patients who underwent RMB, p<0.001 for each. In multivariable models, RMB was not significantly associated with complications, however, those who underwent RMB were less likely to have benign disease 12% (95% CI 9-15%) versus 22% (95% CI 19-25%).

Questions from the audience addressed the high rates of benign diagnoses after RMB which clinically do not make sense, and the significantly higher rates of mortality in the RMB cohort on univariate analysis, drawing attention to the validity of the database.

The authors concluded that RMB has a higher risk of mortality and other complications which should be balanced with the risk of undergoing unnecessary surgery in patients with benign or indolent lesions.

Presented by: Christopher Wallis, MD Urology Resident, University of Toronto 

Authors: Christopher Wallis , Alaina Garbens1, Zachary Klaassen2, Ronald Kodama1, Sender Herschorn1, Robert Nam3
Authors Affiliations: 1University of Toronto 2Georgia Cancer Center, Augusta University - Medical College of Georgia, 3Sunnybrook Research Institute

Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois