Renal mass biopsy mandate tied to fewer surgeries, greater surveillance

Implementation of the mandate on preablation renal mass biopsy appears to result in the wider use of biopsies for all small renal mass patients, fewer surgical interventions, and an increase in active surveillance, reports a recent study.

A team of investigators performed a retrospective analysis of a prospectively managed database designed to track patients with small renal masses who presented at the Kidney Tumor Program from 2000 to 2020.

Patients were divided into pre- and postmandate cohorts based on the initial encounter date, excluding those from April 2017 to April 2018 to allow for implementation of the mandate. Those with masses >4 cm were also excluded.

No significant difference was observed between the pre- and postmandate cohorts, except for race. The implementation of the mandate correlated with an increase in biopsies for both ablation (p<0.001) and nonablation (p=0.01) treatment pathways.

The rates of renal mass biopsy increased in all socioeconomic groups, with the exception of the lowest quartile. In addition, the highest biopsy rate was observed in Black/Hispanic patients.

Significant changes in treatment decisions were noted between the two cohorts: surgery decreased 24 percent (p<0.001), active surveillance increased 28 percent (p<0.001), and patients with no follow-up decreased 8 percent (p=0.03).

“To prevent avoidable treatment and make more informed care decisions about small renal masses, the use of renal mass biopsies has increased since the early 2000s,” the investigators said. “In April 2017, Atrium Health Carolinas Medical Center began requiring biopsies before all percutaneous thermal ablation procedures for renal masses.”