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UPJ INSIGHT Guideline Compliance Regarding Chest Imaging of Suspicious cT1 Renal Masses in MUSIC-KIDNEY

By: Alice Semerjian, MD, Trinity Health IHA, Ann Arbor, Michigan; Kevin Ginsburg, MD, MS, Wayne State University, Detroit, Michigan; Ji Qi, MS, University of Michigan, Ann Arbor; Anna Johnson, MS, University of Michigan, Ann Arbor; Sabrina Noyes, BS, Spectrum Health, Grand Rapids, Michigan; Craig Rogers, MD, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Brian R. Lane, MD, PhD, Spectrum Health, Grand Rapids, Michigan, For the Michigan Urological Surgery Improvement Collaborative | Posted on: 30 Aug 2023

Semerjian A, Ginsburg K, Qi J, et al. Guideline compliance regarding chest imaging of suspicious cT1 renal masses in MUSIC-KIDNEY. Urol Pract. 2023;10(4):327-333.

Study Need and Importance

Although recommended by most major urological societies, appropriate chest imaging for staging of patients who present with renal masses is often overlooked. Moreover, the guidelines remain vague for determining which patients should get staging exams and what type of imaging study should be ordered.

What We Found

A significant proportion of patients presenting with renal masses do not get staging chest imaging of any type. This remained true in renal masses greater than 5 cm. Despite Michigan Urological Surgery Improvement Collaborative guideline dissemination, education, and value-based reimbursement incentive, completion of recommended imaging and type was not routinely performed (see Figure). At the practice level, significant variation in compliance with chest imaging remained.

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Figure. Percentage of cases with no chest imaging, chest x-ray, computerized tomography (CT), or both sorted by renal mass size. As size of renal mass increases, recommendations for chest imaging performance of type chance. The colored borders represent whether chest imaging performance or type is acceptable (blue), recommended (green), or not recommended (red) in each size stratum.

Limitations

Our study excluded higher-stage renal cell carcinoma at presentation and only focused on stage I renal cell carcinoma. Additionally, we only looked at imaging rates related to radiographical renal mass size and did not incorporate other clinical findings. There are some inherent limitations to the data collection, including reason for chest imaging and whether it was ordered and not completed.

Interpretation for Patient Care

Across a statewide collaborative with a variety of practice types and settings represented, compliance with guidelines for staging chest imaging remains low. Even in patients presenting with renal masses greater than 5 cm, recommended imaging is not obtained, potentially resulting in missed metastatic disease.

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