Does renal mass biopsy influence multidisciplinary treatment recommendations?

Area of Science:

• Urology
• Radiology
• Pathology

Background:

• Small renal masses (SRMs) management is complex.
• Multidisciplinary team (MDT) input is crucial for optimal decision-making.
• The role of renal mass biopsy (RMB) in MDT settings requires further investigation.

Purpose of the Study:

• To evaluate the impact of incorporating RMB into MDT decision-making on management strategies for SRMs.
• To assess the diagnostic yield and concordance of RMB.
• To analyze changes in treatment recommendations (surveillance, ablation, surgery) based on RMB results.

Main Methods:

• A monthly MDT conference including radiologists, pathologists, and urologists was established.
• Standardized 18-gauge core needle RMB under ultrasound guidance was performed.
• Patient demographics, comorbidities, tumor pathology, and imaging features were reviewed.
• Descriptive statistics analyzed RMB's influence on management decisions.

Main Results:

• 66% of 83 discussed SRMs underwent RMB, with an 87% diagnostic rate.
• RMB led to increased recommendations for active surveillance (34% vs. 64%) and ablation (38% vs. 7%).
• Partial nephrectomy rates remained similar; histology concordance was 93% in post-biopsy nephrectomy cases. Complication rate was 1.5%.

Conclusions:

• RMB provides valuable diagnostic information for SRMs, with a high diagnostic rate (85%).
• Integrating RMB into MDT discussions enhances shared decision-making.
• RMB facilitates personalized management, guiding towards nephron-sparing options and active surveillance.