MP80-16 PRACTICE PATTERNS OF RENAL MASS BIOPSY ACROSS MUSIC KIDNEY, A STATE WIDE COLLABORATIVE

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP80)1 Apr 2020MP80-16 PRACTICE PATTERNS OF RENAL MASS BIOPSY ACROSS MUSIC KIDNEY, A STATE WIDE COLLABORATIVE Amit Patel*, Anna Johnson, Ji Qi, Sabrina Noyes, Edward Schervish, Alice Semerjian, Brian Lane, Craig Rogers, and for the Michigan Urological Surgery Improvement Collaborative Amit Patel*Amit Patel* More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Ji QiJi Qi More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Edward SchervishEdward Schervish More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Brian LaneBrian Lane 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.0000000000000972.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although renal mass biopsy (RMB) aids decision making, hesitations regarding safety and diagnostic accuracy have led to varied utilization across the United States. The Michigan Urological Surgery Improvement Collaborative (MUSIC) implemented a statewide QI initiative for patients diagnosed with a clinical stage T1 (localized, ≤7 cm) renal mass (cT1RM) in Michigan. This QI initiative provides an opportunity to assess the use of RMB for cT1RM evaluated across a range of practices types. METHODS: MUSIC KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) commenced data collection in 09/2017. Data abstractors recorded clinical, radiographic, pathologic, and short-term follow-up data into the registry for patients (pts) with a newly-diagnosed SRM across 122 datasets at a single time point (120 days after initial consultation). Data from 965 patients evaluated at 13 practices from 9/2017-4/2019 were analysed. RESULTS: RMB was performed in 17.3% (n=167). Within the 13 practices, RMB use ranged from 0-67% (p=0.01). No differences were seen in age, gender, race, BMI, GFR or multiple lesions. Rates of RMB varied with tumor size, with highest rates for the 1-4 cm range (p=0.01). On multivariate analysis, predictors of RMB included greater comorbidity (Charlson score ≥2 vs 0: OR 2.90, p=0.002), academic practice (OR 3.17, p=0.021), and solid tumor type (OR 3.32, p=0.018). RMB was performed with low morbidity; 87% (n=136) were performed with same-day discharge. Six pts (3.7%) attended an ER in <30 days, and 5 of these (3.0%) required readmission. Pathology revealed cancer/suspicion of cancer in 74% and benign findings in 20%. No definite diagnosis was made in the remaining 10 pts (6%). The benign histology rate at surgical intervention in RMB naïve pts was 13% vs 8% in RMB pt (p=.0025); 14 RMB naïve pts underwent radical nephrectomy (RN) with benign histology (10.6%) vs. 1pt with prior RMB(3%). This pt was misclassified at RMB as having RCC when at surgical pathology was found to have an oncocytoma. CONCLUSIONS: Within the MUSIC collaborative there is varied utilisation of RMB across practices. Predictors of RMB included solid tumor type, Charlson score ≥2, and academic urology group. RMB was rarely employed in tumors <1cm. Although RMB only modestly reduced the benign histology rate at surgical intervention, the rate of RN for benign histology is low. QI opportunities appear to exist to increase the utilization of RMB across Michigan and ultimately reduce overtreatment of the cT1RM. Source of Funding: Blue Cross Blue Shield of Michigan © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1232-e1232 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amit Patel* More articles by this author Anna Johnson More articles by this author Ji Qi More articles by this author Sabrina Noyes More articles by this author Edward Schervish More articles by this author Alice Semerjian More articles by this author Brian Lane 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 PDF downloadLoading ...