MP40-03 TRENDS IN THE UTILIZATION OF PERCUTANEOUS RENAL MASS BIOPSY TO GUIDE THE MANAGEMENT OF RENAL MASSES: A POPULATION-BASED ANALYSIS

Abstract

You have accessJournal of UrologyKidney Cancer; Evaluation/Staging IV1 Apr 2014MP40-03 TRENDS IN THE UTILIZATION OF PERCUTANEOUS RENAL MASS BIOPSY TO GUIDE THE MANAGEMENT OF RENAL MASSES: A POPULATION-BASED ANALYSIS Tudor Borza, Ramdev Konijeti, Adam Feldman, Benjamin Chung, and Steven Chang Tudor BorzaTudor Borza More articles by this author , Ramdev KonijetiRamdev Konijeti More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1338AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The traditional paradigm for the management of renal masses involves therapy without a tissue diagnosis. However, there is a growing body of evidence supporting the use of percutaneous renal mass biopsy (RMB) to guide therapy to identify tumors not appropriate for surgery. Therefore, we sought to characterize trends in RMB utilization using a population-based cohort. Methods We captured patients with a renal mass by identifying individuals in the Premier Perspective Database (Premier, Inc, Charlotte, NC) based on ICD9 codes for radical nephrectomy (55.51 who underwent a radical nephrectomy (ICD9 55.51, 55.52, 55.54), partial nephrectomy (55.4), ablation (55.32-55.39) and percutaneous renal biopsy (55.23); all patients had a concomitant diagnosis consistent with a renal mass (189.0-189.1, 196.x, 198.8x, 223.0-223.1, 236.91, 593.2, 594.9, 753.3, V10.52-V10.53). Patients were assumed to have a RMB to guide therapy if it was performed on a date separate from any intervention. We performed trend analysis to assess RMB utilization and multivariable logistic regression adjusting for survey weights and hospital clustering to identify characteristics associated with RMB utilization. Results Our study cohort included a weighted sample of 354,803 patients with renal masses and 23,311 who underwent a RMB to guide therapy. Trend analysis demonstrated that the proportion of patients undergoing RMB has remained stable at 6-7% annually during the study period. Predictors of undergoing RMB included age ≥80, African-American and Hispanic ethnicity, elevated Charlson Comorbidity Index, coverage with Medicaid or Other insurance while predictors for not undergoing RMB included age from 60-69, private insurance, and rural hospitals (Table 1). Conclusions In the United States, RMB is an underutilized diagnostic study for patients with renal masses, and the proportion of patients undergoing this test has not changed despite recent literature. We speculate that RMB is preferentially used to confirm a malignancy in patients who are poor candidates for intervention. Further research into the appropriate indications and the barriers to use for RMB is warranted. Table 1. Multivariable logistic regression model assessing the utilization of renal mass biopsy (RMB) among patients with renal masses in the United States, 2003 to 2010. Patient Characteristics Adjusted OR for RMB 95% CI p-value Age (years) <50 Reference Reference 50 to 59 0.9 0.8 to 1 0.2 60 to 69 0.8 0.7 to 1 0.028 70 to 79 0.9 0.7 to 1.1 0.191 ≥80 1.5 1.2 to 1.9 0.001 Gender Male Reference Reference Female 1.04 0.95 to 1.1 0.4 Race White Reference Reference Black 1.6 1.4 to 1.9 <0.0001 Hispanic 1.6 1.2 to 2.3 0.006 Other 1.2 1 to 1.5 0.1 Charlson Comorbidity Index 0 Reference Reference 1 1.4 1.2 to 1.5 <0.0001 ≥2 3.2 2.9 to 3.6 <0.0001 Insurance Status Medicare Reference Reference Medicaid 1.5 1.2 to 1.9 0.001 Private Insurance 0.7 0.6 to 0.8 <0.0001 Other 1.6 1.3 to 1.96 <0.0001 Hospital Characteristics Teaching Hospital Yes Reference Reference No 1.2 0.9 to 1.4 0.2 Urban Yes Reference Reference No 0.7 0.5 to 0.98 0.04 Hospital Size <200 beds Reference Reference 200 to 399 beds 0.9 0.6 to 1.3 0.6 400 to 599 beds 1.2 0.8 to 1.8 0.3 ≥600 beds 0.99 0.7 to 1.5 0.95 Region Midwest Reference Reference Northeast 1.1 0.8 to 1.5 0.6 South 0.99 0.8 to 1.3 0.995 West 0.98 0.7 to 1.3 0.9 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e434-e435 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tudor Borza More articles by this author Ramdev Konijeti More articles by this author Adam Feldman More articles by this author Benjamin Chung More articles by this author Steven Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...