Identifying the use and barriers to the adoption of renal tumour biopsy in the management of small renal masses

Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decision making. 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.

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 utilization, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents.

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.

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.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2018 Apr 06 [Epub ahead of print]

Patrick O Richard, Lisa Martin, Luke T Lavallée, Philippe D Violette, Maria Komisarenko, Andrew J Evans, Kunal Jain, Michael A S Jewett, Antonio Finelli

Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du CHUS and the University of Sherbrooke, Sherbrooke, QC., Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON., Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON., Division of Urology, Department of Surgery, Woodstock General Hospital and Division of Urology, Department of Surgery, McMaster University, Hamilton, ON., Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON; Canada.