@article{cdb1750150114ade9a78277c5b8cb4e8,
title = "Influence of renal biopsy results on the management of small kidney cancers in older patients: Results from a population-based cohort",
abstract = "Background and objective Small kidney cancers are a heterogeneous group with varying malignant potential. Pathologic information obtained from a renal biopsy may guide decision-making for small kidney cancers. We sought to assess the effect of pathologic information from renal biopsy on the nonsurgical management of small kidney cancers in a population-based cohort of patients over 65 years of age. Methods In the Surveillance, Epidemiology and End Results-Medicare dataset, we identified patients ≥66 years diagnosed with a kidney cancer<4 cm between 2002 and 2011. Diagnostic biopsy was defined by a Medicare claim within 1 month prior through 6 months following cancer diagnosis or before surgery. Nonsurgical management was defined by the absence of a claim for partial or radical nephrectomy or tumor ablation in the first 6 months following diagnosis. The relationship between patient and tumor characteristics and the likelihood of nonsurgical management by receipt of diagnostic biopsy was assessed by multivariable logistic regression models. Results From 8,933 patients, 2,782 (31%) had a diagnostic renal biopsy of whom 616 (22%) were managed nonsurgically. Controlling for patient, disease, and provider specialty, biopsy was associated with nonsurgical management (adjusted odds ratio = 1.61, 95% Cl: 1.43–1.82) in patients with low-grade tumors but also with more aggressive histology (clear cell renal cell carcinoma). Older age (85+) and geographic region were significantly associated with greater odds of diagnostic biopsy. Patients whose initial renal tumor diagnosis was made by a urologist (vs. other type of provider) were less likely to receive a biopsy (adjust odds ratio = 0.73, 95% Cl: 0.60–0.89). Conclusions Although the use of renal biopsy has increased over time and is associated with the use of nonsurgical management of small kidney cancers, the use of the pathologic findings remains limited. Further advances, particularly with prognostic markers, are necessary before renal biopsy can be routinely implemented for treatment decision-making for small kidney cancers.",
keywords = "Management, Nonoperative management, Renal biopsy, Risk stratification, Small kidney cancer, Surgery",
author = "Bjurlin, {Marc A.} and Elkin, {Elena B.} and Atoria, {Coral L.} and Paul Russo and Taneja, {Samir S.} and Huang, {William C.}",
note = "Funding Information: This study used the linked SEER-Medicare dataset. The interpretation and reporting of these data are the sole responsibility of the authors. M.A.B. was supported in part by grant UL1 TR000038 from the National Center for the Advancement of Translational Sciences (NCATS), National Institutes of Health, United States, and by a Cancer Center Support Grant from the National Cancer Institute, United States (P30CA008748). Funding Information: This study used the linked SEER-Medicare dataset. The interpretation and reporting of these data are the sole responsibility of the authors. M.A.B. was supported in part by grant UL1 TR000038 from the National Center for the Advancement of Translational Sciences (NCATS), National Institutes of Health , United States, and by a Cancer Center Support Grant from the National Cancer Institute , United States ( P30CA008748 ). Appendix Table Code Description Renal biopsy CPT 50,200 Renal biopsy; percutaneous, by trocar or needle 50,205 Renal biopsy; by surgical exposure of kidney 10,021 Fine-needle aspiration; without imaging guidance 10,021 Fine-needle aspiration; with imaging guidance ICD-9 55.23 Closed (percutaneous) (needle) biopsy of kidney 55.24 Open biopsy of kidney 55.92 Percutaneous aspiration of kidney Pathology/cytopathology CPT 88,305 Surgical pathology and kidney biopsy 88,104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation 88,106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation 88,108 Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique) 88,112 Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid-based slide preparation method), except cervical or vaginal 88,120 Cytopathology, in situ hybridization (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual 88,121 Cytopathology, in situ hybridization (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology ICD-9 91.2 Microscopic examination of specimen from kidney, ureter, perirenal, and periureteral tissue Renal surgery CPT 50,220 Nephrectomy, including partial ureterectomy, any open approach including rib resection 50,225 Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney 50,230 Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical with regional lymphadenectomy or vena caval thrombectomy or both 50,240 Nephrectomy, partial 50,543 Laparoscopy, surgical; partial nephrectomy 50,545 Laparoscopy, radical nephrectomy (includes removal of Gerota׳s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy) 50,546 Laparoscopy, nephrectomy, including partial ureterectomy ICD-9 55.3 Local excision or destruction of lesion of kidney 55.4 Partial nephrectomy 55.5 Complete nephrectomy Publisher Copyright: {\textcopyright} 2017 Elsevier Inc.",
year = "2017",
month = oct,
doi = "10.1016/j.urolonc.2017.05.025",
language = "English (US)",
volume = "35",
pages = "604.e1--604.e9",
journal = "Urologic Oncology: Seminars and Original Investigations",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "10",
}