Ablation of Small Renal Masses: Practice Patterns at Academic Institutions in the United States

Abstract

We aimed to determine the current practice patterns at academic institutions in the use of ablative technologies for the management of small renal masses. Mail surveys were sent to 124 academic institutions in the United States. The survey consisted of 12 questions pertaining to institutional demographic information, the use of ablation technology for small renal masses, the role of the urologist in ablation, and biopsy preferences prior to treatment. The overall response rate was 52% (64/124). Ablation was offered by all of the academic centers that responded to the survey and included 73% percutaneous cryoablation, 52% percutaneous radiofrequency ablation, 83% laparoscopic cryoablation, and 20% laparoscopic radiofrequency ablation. Eighty-eight percent of institutions performed one to five total ablation procedures each month. Urologists alone performed 13% of ablation procedures, radiologists performed 45% of ablation procedures, and a combined approach (urologist and radiologist present) was used in 43% of the institutions. When questioned about their role during percutaneous ablation, we found that urologists were present at the time of ablation in 59% of institutions, in 32% of institutions urologists placed the needles for ablation, and in 98% of institutions urologists were responsible for the postoperative care of the patient. Eighty-nine percent of academic institutions performed a biopsy of the renal mass with 67% performing a core biopsy, 5% performing a fine-needle aspiration (FNA), and 28% performing both a core biopsy and FNA. Nineteen percent of institutions performed a renal mass biopsy prior to the day of the procedure so that the pathology was known prior to ablation. Ablative technologies are well utilized for the treatment of small renal masses at current academic institutions with urologists directly involved in the ablation procedure in only half of the institutions. While preablation biopsy is common, pathology is rarely known prior to ablation.