Patterns of renal mass biopsy across the MUSIC-KIDNEY statewide QI collaborative
Patel A, Perkins S, Bazzi M, Arcot R, Johnson A, Qi J, Kim T, Ghani K, Schervish E, Lane B, and Rogers C. Patterns of renal mass biopsy across the MUSIC-KIDNEY statewide QI collaborative. Eur Urol Suppl 2019; 18(1):e1231-e1232.
Eur Urol Suppl
Introduction & Objectives: Although renal mass biopsy (RMB)is well established as an aid in treatment decision making, hesitations regarding the safety and diagnostic accuracy have led to varied utilization across the US. The Michigan Urological Surgery Improvement Collaborative: Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY)program is a QI initiative for patients with renal masses ≤7 cm (RM≤7cm). This pilot study provides an opportunity to assess the use of RMB for newly-diagnosed RM≤7cm across a range of practices types. Materials & Methods: MUSIC-KIDNEY commenced data collection in September 2017 at 8 diverse MUSIC practices. Data abstractors recorded 122 data points at a single time point (120 days after initial consultation)with subsequent extraction at least 3 months later if final treatment assignment had not been made. Results: Data was collected for 581 patients with RM≤7cm, of which 71 (12.2%)underwent a RMB. RMB utilization across the 8 sites ranged from 0-23% (median 11%), with 11% of RMB performed by an urologist. No statistical differences in patient and tumor characteristics were observed between those having or not having RMB (Table 1); 2 patients (2.8%)were evaluated in the emergency department (with 1 hospitalization)following RMB. The non-diagnostic rate of RMB across the collaborative was only 5.6% (n=4); the remaining RMB were categorized as benign (n=16, 22.5%), favor malignancy (n=4, 5.6%), or malignant (n=47, 66.2%). Patients with a benign biopsy were more likely to be surveilled then patients managed without RMB (81% vs 48%, p=0.009)and 15 patients (25%)with malignancy at RMB were still surveilled. The benign histology rate at surgery in RMB naïve patients was 13.1% vs 3.03% with RMB (p=0.09). [Table Presented][Table Presented] Conclusions: This pilot study of RMB across a state-wide collaborative showed significant variability in utilization of RMB and a favorable non-diagnostic rate compared to the literature. Only 3% of patients in the RMB cohort had benign histology at surgical intervention as compared to 13% with no prior biopsy. Given the low overall use of RMB across the MUSIC-KIDNEY practices, increased utilisation could reduce the number of surgeries for benign RM≤7cm.