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JU INSIGHT Renal Mass Biopsy Mandate Is Associated With Change in Treatment Decisions
By: Alexander Sinks, BS, Wake Forest School of Medicine, Winston-Salem, North Carolina; Caroline Miller, BS, University of North Carolina School of Medicine, Chapel Hill; Hailey Holck, BS, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Laurel Zeng, MS, Levine Cancer Institute, Charlotte, North Carolina; Kris Gaston, MD, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, UT Southwestern, Dallas, Texas; Stephen Riggs, MD, MBA, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Justin Matulay, MD, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Peter E. Clark, MD, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina; Ornob Roy, MD, MBA, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina | Posted on: 20 Jul 2023
Sinks A, Miller C, Holck H, et al. Renal mass biopsy mandate is associated with change in treatment decisions. J Urol. 2023;210(1):72-78.
Study Need and Importance
To prevent avoidable treatment and make more informed care decisions about small renal masses, the use of renal mass biopsies (RMBs) has increased since the early 2000s. However, the true utility of RMBs has been debated due in part to poor nondiagnostic rates and negative predictive value. In April 2017, Atrium Health Carolinas Medical Center began requiring biopsies before all percutaneous thermal ablation procedures for renal masses. We aim to determine the effect of this preablation biopsy mandate on both malignant and benign small renal mass treatment decisions.
What We Found
Overall, we found no significant difference between the pre- and postmandate cohorts, with race as an exception. Implementation of the mandate coincided with an increase in biopsies for both ablation and nonablation treatment pathways (P < .001, P = .01). RMB rates increased in all socioeconomic groups except the lowest quartile. Additionally, Black/Hispanic patients had the highest biopsy rate. We found significant changes in treatment decisions between our cohorts: surgery decreased 24% (P < .001), active surveillance increased 28% (P < .001; see Figure), and patients with no follow-up decreased 8% (P = .03). Our data indicate that a preablation RMB mandate is associated with the wider use of biopsies for all small renal mass patients, fewer surgical interventions, and an increase in active surveillance.
Limitations
Our single-institution study had unbalanced cohorts with a much larger premandate than postmandate cohort (n=1,035 vs n=167), possibly reducing power and generalizability. Furthermore, the duration of patient follow-up for our postmandate cohort is naturally shorter than for our premandate cohort, which could confound our treatment measures.
Interpretation for Patient Care
The implementation of a preablation biopsy mandate corresponded with a change in treatment decisions for patients with renal masses, increasing minimally invasive treatments and decreasing surgical treatment use.
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