Building a Roadmap for Surveillance of Renal Masses using a modified Delphi Method to help Achieve Consensus
Patel AK, Butaney M, Lane BR, Wilder S, Johnson A, Qi J, Wang Y, DiBianco J, Herrel L, Maatman T, Peabody J, Rosenberg B, Seifman B, Semerjian A, Shetty S, Schervish E, Collins J, Tandogdu Z, and Rogers CG. Building a Roadmap for Surveillance of Renal Masses using a modified Delphi Method to help Achieve Consensus. Urology 2023.
OBJECTIVE: To establish a consensus for initial evaluation and follow-up of patients on active surveillance (AS) for T1 renal masses (T1RM).
METHODS: A modified Delphi method was used to gather information about AS of T1RM, with a focus on patient selection, timing/type of imaging modality, and triggers for intervention. A consensus panel of MUSIC-affiliated urologists who routinely manage renal masses was formed. Areas of consensus (defined >80% agreement) about T1RM AS were established iteratively via three rounds of online questionnaires.
RESULTS: Twenty-six MUSIC urologists formed the panel. Consensus was achieved for 321/587 scenarios (54.7%) administered through 124 questions. Life expectancy (LE), age, comorbidity, and renal function were most important for patient selection, with LE ranking first. All tumorsLErisk, increasing tumor complexity, and/or declining renal function. Consensus was for multiphasic axial imaging initially (contrast CT for GFR>60 or MRI for GFR>30) with first repeat imaging at 3-6 months and subsequent imaging timing determined by tumor size. Consensus was for chest imaging for tumors >3 cm initially and >5 cm at follow up. Renal biopsy was not felt to be a requirement for entering AS, but useful in several scenarios. Consensus indicated rapid tumor growth as an appropriate trigger for intervention.
CONCLUSIONS: Our consensus panel was able to achieve areas of consensus to help define a clinically useful and specific roadmap for AS of T1RM and areas for further discussion where consensus was not achieved.
ePub ahead of print