Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy - Could a biopsy have guided management?

Haider Rahbar, Sam Bhayani, Michael Stifelman, Jihad Kaouk, Mohamad E Allaf, Susan Marshall, Homayoun Zargar, Mark W. Ball, Jeffrey Larson, Craig Rogers

Research output: Contribution to journalArticle

Abstract

Purpose: We evaluated a published biopsy directed small renal mass management algorithm using a large cohort of patients who underwent robotic partial nephrectomy for tumors 4 cm or smaller.

Results: Patients were assigned to the pathology risk groups of benign (23%), favorable (13%), intermediate (51%) and unfavorable (12%). Patients were also assigned to the management groups of benign pathology (275, 23%), active surveillance (336, 29%) and treatment (564, 48%). Most of the 611 (52%) patients in the benign or active surveillance groups were low surgical risk and had safe treatment (2.6% high grade complications). A biopsy may not have been feasible or accurate in some tumors that were anterior (378, 32%), hilar (93, 7.9%) or less than 2 cm (379, 32%). Of 129 (11%) high surgical risk patients the biopsy algorithm assigned 70 (54%) to benign or active surveillance groups.

Materials and Methods: A simplified algorithm of biopsy directed small renal mass management previously reported using risk stratified biopsies was applied to 1,175 robotic partial nephrectomy cases from 5 academic centers. A theoretical assumption was made of perfect biopsies that were feasible for all patients and had 100% concordance to final pathology. Pathology risk groups were benign, favorable, unfavorable and intermediate. The algorithm assigned favorable or intermediate tumors smaller than 2 cm to active surveillance and unfavorable or intermediate 2 to 4 cm tumors to treatment. Higher surgical risk patients were defined as ASA® 3 or greater and age 70 years or older.

Conclusions: The theoretical application of a biopsy driven, risk stratified small renal mass management algorithm to a large robotic partial nephrectomy database suggests that about half of the patients might have avoided surgery. Despite the obvious limitations of a theoretical assumption of all patients receiving a perfect biopsy, the data support the emerging role of renal mass biopsies to guide management, particularly in high surgical risk patients.

Original languageEnglish (US)
Pages (from-to)1337-1342
Number of pages6
JournalJournal of Urology
Volume192
Issue number5
DOIs
StatePublished - Nov 1 2014

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Robotics
Nephrectomy
Kidney
Biopsy
Pathology
Neoplasms
Therapeutics
Databases

Keywords

  • biopsy
  • carcinoma renal cell
  • kidney neoplasms

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy - Could a biopsy have guided management? / Rahbar, Haider; Bhayani, Sam; Stifelman, Michael; Kaouk, Jihad; Allaf, Mohamad E; Marshall, Susan; Zargar, Homayoun; Ball, Mark W.; Larson, Jeffrey; Rogers, Craig.

In: Journal of Urology, Vol. 192, No. 5, 01.11.2014, p. 1337-1342.

Research output: Contribution to journalArticle

Rahbar, H, Bhayani, S, Stifelman, M, Kaouk, J, Allaf, ME, Marshall, S, Zargar, H, Ball, MW, Larson, J & Rogers, C 2014, 'Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy - Could a biopsy have guided management?', Journal of Urology, vol. 192, no. 5, pp. 1337-1342. https://doi.org/10.1016/j.juro.2014.06.028
Rahbar, Haider ; Bhayani, Sam ; Stifelman, Michael ; Kaouk, Jihad ; Allaf, Mohamad E ; Marshall, Susan ; Zargar, Homayoun ; Ball, Mark W. ; Larson, Jeffrey ; Rogers, Craig. / Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy - Could a biopsy have guided management?. In: Journal of Urology. 2014 ; Vol. 192, No. 5. pp. 1337-1342.
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abstract = "Purpose: We evaluated a published biopsy directed small renal mass management algorithm using a large cohort of patients who underwent robotic partial nephrectomy for tumors 4 cm or smaller.Results: Patients were assigned to the pathology risk groups of benign (23{\%}), favorable (13{\%}), intermediate (51{\%}) and unfavorable (12{\%}). Patients were also assigned to the management groups of benign pathology (275, 23{\%}), active surveillance (336, 29{\%}) and treatment (564, 48{\%}). Most of the 611 (52{\%}) patients in the benign or active surveillance groups were low surgical risk and had safe treatment (2.6{\%} high grade complications). A biopsy may not have been feasible or accurate in some tumors that were anterior (378, 32{\%}), hilar (93, 7.9{\%}) or less than 2 cm (379, 32{\%}). Of 129 (11{\%}) high surgical risk patients the biopsy algorithm assigned 70 (54{\%}) to benign or active surveillance groups.Materials and Methods: A simplified algorithm of biopsy directed small renal mass management previously reported using risk stratified biopsies was applied to 1,175 robotic partial nephrectomy cases from 5 academic centers. A theoretical assumption was made of perfect biopsies that were feasible for all patients and had 100{\%} concordance to final pathology. Pathology risk groups were benign, favorable, unfavorable and intermediate. The algorithm assigned favorable or intermediate tumors smaller than 2 cm to active surveillance and unfavorable or intermediate 2 to 4 cm tumors to treatment. Higher surgical risk patients were defined as ASA{\circledR} 3 or greater and age 70 years or older.Conclusions: The theoretical application of a biopsy driven, risk stratified small renal mass management algorithm to a large robotic partial nephrectomy database suggests that about half of the patients might have avoided surgery. Despite the obvious limitations of a theoretical assumption of all patients receiving a perfect biopsy, the data support the emerging role of renal mass biopsies to guide management, particularly in high surgical risk patients.",
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AU - Bhayani, Sam

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AU - Allaf, Mohamad E

AU - Marshall, Susan

AU - Zargar, Homayoun

AU - Ball, Mark W.

AU - Larson, Jeffrey

AU - Rogers, Craig

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N2 - Purpose: We evaluated a published biopsy directed small renal mass management algorithm using a large cohort of patients who underwent robotic partial nephrectomy for tumors 4 cm or smaller.Results: Patients were assigned to the pathology risk groups of benign (23%), favorable (13%), intermediate (51%) and unfavorable (12%). Patients were also assigned to the management groups of benign pathology (275, 23%), active surveillance (336, 29%) and treatment (564, 48%). Most of the 611 (52%) patients in the benign or active surveillance groups were low surgical risk and had safe treatment (2.6% high grade complications). A biopsy may not have been feasible or accurate in some tumors that were anterior (378, 32%), hilar (93, 7.9%) or less than 2 cm (379, 32%). Of 129 (11%) high surgical risk patients the biopsy algorithm assigned 70 (54%) to benign or active surveillance groups.Materials and Methods: A simplified algorithm of biopsy directed small renal mass management previously reported using risk stratified biopsies was applied to 1,175 robotic partial nephrectomy cases from 5 academic centers. A theoretical assumption was made of perfect biopsies that were feasible for all patients and had 100% concordance to final pathology. Pathology risk groups were benign, favorable, unfavorable and intermediate. The algorithm assigned favorable or intermediate tumors smaller than 2 cm to active surveillance and unfavorable or intermediate 2 to 4 cm tumors to treatment. Higher surgical risk patients were defined as ASA® 3 or greater and age 70 years or older.Conclusions: The theoretical application of a biopsy driven, risk stratified small renal mass management algorithm to a large robotic partial nephrectomy database suggests that about half of the patients might have avoided surgery. Despite the obvious limitations of a theoretical assumption of all patients receiving a perfect biopsy, the data support the emerging role of renal mass biopsies to guide management, particularly in high surgical risk patients.

AB - Purpose: We evaluated a published biopsy directed small renal mass management algorithm using a large cohort of patients who underwent robotic partial nephrectomy for tumors 4 cm or smaller.Results: Patients were assigned to the pathology risk groups of benign (23%), favorable (13%), intermediate (51%) and unfavorable (12%). Patients were also assigned to the management groups of benign pathology (275, 23%), active surveillance (336, 29%) and treatment (564, 48%). Most of the 611 (52%) patients in the benign or active surveillance groups were low surgical risk and had safe treatment (2.6% high grade complications). A biopsy may not have been feasible or accurate in some tumors that were anterior (378, 32%), hilar (93, 7.9%) or less than 2 cm (379, 32%). Of 129 (11%) high surgical risk patients the biopsy algorithm assigned 70 (54%) to benign or active surveillance groups.Materials and Methods: A simplified algorithm of biopsy directed small renal mass management previously reported using risk stratified biopsies was applied to 1,175 robotic partial nephrectomy cases from 5 academic centers. A theoretical assumption was made of perfect biopsies that were feasible for all patients and had 100% concordance to final pathology. Pathology risk groups were benign, favorable, unfavorable and intermediate. The algorithm assigned favorable or intermediate tumors smaller than 2 cm to active surveillance and unfavorable or intermediate 2 to 4 cm tumors to treatment. Higher surgical risk patients were defined as ASA® 3 or greater and age 70 years or older.Conclusions: The theoretical application of a biopsy driven, risk stratified small renal mass management algorithm to a large robotic partial nephrectomy database suggests that about half of the patients might have avoided surgery. Despite the obvious limitations of a theoretical assumption of all patients receiving a perfect biopsy, the data support the emerging role of renal mass biopsies to guide management, particularly in high surgical risk patients.

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