1300 ESTIMATING THE BURDEN OF PREOPERATIVELY MISCLASSIFIED, SURGICALLY REMOVED BENIGN RENAL MASSES IN THE UNITED STATES: IMPLICATIONS FOR THE CURRENT STANDARD OF CARE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (II)1 Apr 20131300 ESTIMATING THE BURDEN OF PREOPERATIVELY MISCLASSIFIED, SURGICALLY REMOVED BENIGN RENAL MASSES IN THE UNITED STATES: IMPLICATIONS FOR THE CURRENT STANDARD OF CARE David Johnson, Angela Smith, Josip Vukina, Jed Ferguson, Will Kirby, Mathew Raynor, Michael Woods, Eric Wallen, Raj Pruthi, and Matthew Nielsen David JohnsonDavid Johnson Chapel Hill, NC More articles by this author , Angela SmithAngela Smith Chapel Hill, NC More articles by this author , Josip VukinaJosip Vukina Chapel Hill, NC More articles by this author , Jed FergusonJed Ferguson Chapel Hill, NC More articles by this author , Will KirbyWill Kirby Chapel Hill, NC More articles by this author , Mathew RaynorMathew Raynor Chapel Hill, NC More articles by this author , Michael WoodsMichael Woods Chapel Hill, NC More articles by this author , Eric WallenEric Wallen Chapel Hill, NC More articles by this author , Raj PruthiRaj Pruthi Chapel Hill, NC More articles by this author , and Matthew NielsenMatthew Nielsen Chapel Hill, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2654AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of renal cell carcinoma (RCC) is increasing and the average size at diagnosis is decreasing. Surgical resection without tissue confirmation is within the standard of care for renal masses suspicious for RCC, which results in a currently unknown number of preoperatively misclassified benign renal masses (BRM) undergoing nephrectomy. Against this backdrop, we estimate the population-level burden of surgically removed benign renal masses in the US. METHODS A literature review for studies providing estimates of the likelihood of BRM for resected renal masses was conducted. Studies reporting the likelihood of BRM based on tumor size (<1.0 cm, 1-2 cm, 2-3 cm, 3-4 cm, 4-7 cm, >7 cm) were included. The results were pooled for a single estimate of likelihood of BRM for each size category. Combining these results with size-specific incidence rates of RCC from SEER and population estimates from census data, we estimated the burden of surgically resected BRM for 2000 and 2009. RESULTS The size-specific likelihood of BRM was compiled from 4 studies of tumors <4 cm and 5 studies of tumors > 4 cm. The pooled estimates of the likelihood of benign histology are 41.2%, 21.5%, 20.3%, 17.7%, 9.3%, and 6.4% for <1 cm, 1-2 cm, 2-3 cm, 3-4 cm, 4-7 cm, and > 7 cm tumors, respectively. The estimated number of surgically resected benign renal masses in the United States in 2000 and 2009 for these respective size strata are 198 and 428, 386 and 1087, 790 and 1866, 788 and 1379, 925 and 1283, and 675 and 751. Overall, the estimates for preoperatively misclassified BRM undergoing surgical resection are 3762 in 2000 and 6794 in 2009, representing an 80% increase. CONCLUSIONS Given the evolving epidemiology of RCC, the burden of preoperatively misclassified BRM is an important and previously unstudied phenomenon, as no specific data are available to directly quantify this. These indirect estimates suggest the burden may be quite substantial and potentially increasing at a dramatic rate. These data underscore an important dimension of overtreatment due to unnecessary morbidity, mortality and health care costs. Furthermore, long-term effects on renal and cardiovascular health must also be considered, particularly given the still substantial proportion of the population who undergo radical nephrectomy, even for small masses. These data support further consideration of the role of renal mass biopsy and other strategies to optimize management. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e531 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Johnson Chapel Hill, NC More articles by this author Angela Smith Chapel Hill, NC More articles by this author Josip Vukina Chapel Hill, NC More articles by this author Jed Ferguson Chapel Hill, NC More articles by this author Will Kirby Chapel Hill, NC More articles by this author Mathew Raynor Chapel Hill, NC More articles by this author Michael Woods Chapel Hill, NC More articles by this author Eric Wallen Chapel Hill, NC More articles by this author Raj Pruthi Chapel Hill, NC More articles by this author Matthew Nielsen Chapel Hill, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...