MP61-09 INITIAL MANAGEMENT OF INDETERMINATE RENAL MASSES IN A STATEWIDE COLLABORATIVE:A MUSIC-KIDNEY ANALYSIS

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP61)1 Sep 2021MP61-09 INITIAL MANAGEMENT OF INDETERMINATE RENAL MASSES IN A STATEWIDE COLLABORATIVE:A MUSIC-KIDNEY ANALYSIS Mohit Butaney, Amit Patel, Brian Lane, Ji Qi, Anna Johnson, Craig Rogers, and for the Michigan Urological Surgery Improvement Collaborative Mohit ButaneyMohit Butaney More articles by this author , Amit PatelAmit Patel More articles by this author , Brian LaneBrian Lane More articles by this author , Ji QiJi Qi More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Craig RogersCraig Rogers More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002101.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The widespread use of imaging has led to the increasing detection of incidental renal lesions. Although some may be accurately classified as suspicious (renal cell carcinoma) and others as benign (Bosniak I-IIF cysts or angiomyolipomas), other lesions are best initially characterized as ‘indeterminate’, for example when they cannot be determined to be enhancing without additional imaging sequences. Optimal management is not well understood. We assess the use of follow up imaging in the management of indeterminate renal lesions(IRL). METHODS: The Michigan Urological Surgery Improvement Collaborative—Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) commenced data collection in September 2017 by recording clinical, radiographic, pathologic, and follow-up data at 13 diverse practices. At initial evaluation, data was recorded regarding the radiologist interpretation of each imaging study (suspicious, indeterminate, benign) as well as the clinician’s assessment. Patients with complete data were assessed at 120 days after initial evaluation as to whether observation or treatment was performed. RESULTS: 19.6% (472/2413) patients(pts) were recorded as having an IRL at their initial imaging study, of which 36% had non-contrast imaging. 23.9% (113/472) of pts with IRL underwent subsequent imaging(SI), of which 59.3% (67/113) were re-classified as solid enhancing lesions, 20.4% as benign lesions, with only 20.4% IRL remaining. Of these 113 pts with repeat imaging, 17 underwent biopsy (15 malignant, 1 benign, 1 indeterminate) and 10 of 15 patients with cancer on biopsy underwent treatment, while the remaining selected surveillance. Pts with initial IRL reclassified to suspicious were less likely to have benign histology at pre-treatment biopsy (8.7% vs. 9.7%) or surgery (6.1% vs. 10.5%) compared with lesions initially characterized as suspicious, but these did not reach statistical significance. CONCLUSIONS: Until now, outcomes of indeterminate renal masses have been poorly understood. About 80% of patients with indeterminate renal lesions can be reclassified with subsequent dedicated imaging. Patients with benign renal lesions, including Bosniak I-IIF cysts, T1a AMLs, and other non-enhancing lesions or pseudotumors can be reassured and should not undergo intervention. Initial contrast axial imaging, the addition of further imaging and consideration of biopsy more fully characterizes an indeterminate renal lesion, often affecting subsequent management. Source of Funding: Funding from Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1086-e1086 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohit Butaney More articles by this author Amit Patel More articles by this author Brian Lane More articles by this author Ji Qi More articles by this author Anna Johnson More articles by this author Craig Rogers More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Loading ...