Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

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.

Figure. Percent of patients on active surveillance by year, with patients ranging from 2000-2020. The red vertical line denotes the time when the preablation biopsy mandate was implemented.

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.

advertisement

advertisement