MD,PHD Department of oncology, Sahlgrenska University Hospital, Gothenburg, Sweden Askim, Vastra Gotaland, Sweden
Background: Renal tumor biopsies( RTB) increase the diagnostic precision before embarking on treatment of suspect renal cell carcinoma( RCC). This is of special importance in tumors up to 4 cm of which up to 30% are benign and the treatment options may include surgery, ablation,active surveillance or no treatment. It has been shown that active treatment could be avoided in 28% of small renal masses (SRM) by pretreatment RTB( Ref) We have studied the use of pretreatment RTB for treatment decision in a national cohort of patients with T1a RCC
Methods: Patients withT1a RCC without metastases registered in the National Swedish Kidney Cancer Register (99% of RCCs diagnosed in Sweden) 2009-2021 were studied. Core biopsies before the date of treatment were registered. Radical nephrectomy(RN) was performed in 1358(23%), partial nephrectomy(PN) in 3262( 56%), tumor ablation(TA) in 552(9%) and active surveillance or no treatment in 661(11%) patients.
Results: The use of pretreatment biopsy increased from 2009 to 2021, overall from 14 to 34% of the patients, in RN from 9 to 18%, in PN from 9 to 12%, in TA from 20 to 96% and in AS or no treatment there was no obvious change over the years with a mean of 53% (range 38-68).
Conclusions: Pretreatment RTB increased during time to be performed in most patients before TA according to current guidelines. Although pretreatment biopsies increased slightly before RN and PN, RTB probably was underutilized considering the high incidence of benign tumors among SMRs. An increased use of pretreatment biopsy for decision of treatment is one way to avoid overtreatment of patients with SMRs.
Reference: Amaral, B.S., et al. Renal Tumor Biopsy: Rationale to Avoid Surgery in Small Renal Masses. Curr Urol Rep, 2021. 22: 46. https://pubmed.ncbi.nlm.nih.gov/34487255/
