710 ACCURACY OF DETERMINING SMALL RENAL MASS (SRM) MANAGEMENT WITH RISK-STRATIFIED BIOPSIES CONFIRMATION BY FINAL PATHOLOGY

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2012710 ACCURACY OF DETERMINING SMALL RENAL MASS (SRM) MANAGEMENT WITH RISK-STRATIFIED BIOPSIES CONFIRMATION BY FINAL PATHOLOGY Schuyler J. Halverson, Adam J. Gadzinski, Lakshmi Priya Kunju, David C. Miller, Jeffrey S. Montgomery, Alon Z. Weizer, J. Stuart Wolf, and Khaled S. Hafez Schuyler J. HalversonSchuyler J. Halverson Ann Arbor, MI More articles by this author , Adam J. GadzinskiAdam J. Gadzinski Ann Arbor, MI More articles by this author , Lakshmi Priya KunjuLakshmi Priya Kunju Ann Arbor, MI More articles by this author , David C. MillerDavid C. Miller Ann Arbor, MI More articles by this author , Jeffrey S. MontgomeryJeffrey S. Montgomery Ann Arbor, MI More articles by this author , Alon Z. WeizerAlon Z. Weizer Ann Arbor, MI More articles by this author , J. Stuart WolfJ. Stuart Wolf Ann Arbor, MI More articles by this author , and Khaled S. HafezKhaled S. Hafez Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.794AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our algorithm for SRMs (< 4 cm) calls for routine percutaneous biopsy, with management recommendation driven largely by risk stratification of the biopsy result. We assessed the accuracy of biopsy risk stratification in determining treatment versus active surveillance (AS), as confirmed using pathology from the final excision. METHODS Among 151 patients with SRM who underwent biopsy and subsequent surgical excision, 135 had biopsy results revealing cell type and grade allowing categorization into Unfavorable (U), Intermediate (I) or Favorable (F) risk groups. Although our complete algorithm also takes into account performance status and tumor depth, management is determined primarily by SRM size and biopsy risk group. U biopsy results lead to treatment regardless of SRM size. I biopsy results prompt treatment for SRM > 2 cm, but AS if < 2 cm. AS is recommended for all SRM with F biopsy results. We compared the management recommendation determined using the biopsy result with the management which would have been recommended based on the surgical pathology. RESULTS Based on biopsy, 19 (14%), 100 (74%), and 16 (12%) patients were placed into U, I, and F risk groups. Combining with size (102 SRM > 2 cm, 33 SRM < 2 cm), our algorithm called for AS for 11 SRM > 2 cm and 28 SRM < 2 cm, and for treatment of 91 SRM > 2 cm and 5 SRM < 2 cm (Table). Based upon the final surgical pathology, 13 patients initially assigned to AS would have been assigned to the treatment group (9.6% of all patients, 33% of those recommended for AS), whereas no patients moved from treatment group to AS group. Kappa between management groups determined by the biopsy and final pathologies = 0.74. Using management based on final pathology as the reference standard, biopsy had a NPV = 0.67 and PPV = 1.0 for determining management. Of the 13 mis-classified patients, 7 had a biopsy indicating grade 1 clear cell renal cancer which was upgraded to grade 2 (5) or grade 3 (2). CONCLUSIONS Using risk stratification of SRM biopsy in an algorithm for SRM management appears to be justified, as management recommendation based on biopsy result has 90% concordance with risk stratification by final pathology. Undergrading of clear cell renal cancer on biopsy accounts for most of the discrepancies in risk group assignment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByPrince J, Bultman E, Hinshaw L, Drewry A, Blute M, Best S, Lee F, Ziemlewicz T, Lubner M, Shi F, Nakada S and Abel E (2018) Patient and Tumor Characteristics can Predict Nondiagnostic Renal Mass Biopsy FindingsJournal of Urology, VOL. 193, NO. 6, (1899-1904), Online publication date: 1-Jun-2015. Volume 187Issue 4SApril 2012Page: e291 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Schuyler J. Halverson Ann Arbor, MI More articles by this author Adam J. Gadzinski Ann Arbor, MI More articles by this author Lakshmi Priya Kunju Ann Arbor, MI More articles by this author David C. Miller Ann Arbor, MI More articles by this author Jeffrey S. Montgomery Ann Arbor, MI More articles by this author Alon Z. Weizer Ann Arbor, MI More articles by this author J. Stuart Wolf Ann Arbor, MI More articles by this author Khaled S. Hafez Ann Arbor, MI More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...