PracticeUpdate: Haematology & Oncology

CONFERENCE COVERAGE 8

European Cancer Congress 2017

27–30 JANUARY 2017 | AMSTERDAM, THE NETHERLANDS

ECCO2017 brings together Europe’s oncology professionals in a multidisciplinary forum to progressively think on cancer policy, training and education, cancer research, prevention, diagnosis and treatment of cancer patients. This year’s meeting touched on various topics including identifying key molecular events, use of biopsy in small renal masses, multiparametric MRI being superior to PET and CT, and the outcomes of phase1b KEYNOTE-012 trial.

Biopsies of small renal masses help avoid unnecessary surgery B iopsy of small renal masses is a way to reduce overtreatment, cost, and most important, treatment-related mor- bidity, concludes results of a retrospective, single-centre study. Dr McPhee and colleagues proposed to val- idate the safety, accuracy, and reliability of renal biopsy in their centre. They also eval- uated the use of biopsies to guide treatment decisions.

Recent series from Richard et al in Toronto have shown concordance rates of 90%. Dr McPhee’s series showed a 100% concord- ance rate of biopsy with surgical histology. Grading of renal biopsy was not routinely reported, so whether this level of concord- ance would apply to tumour grading could not be confirmed. Dr McPhee concluded that the study provides further evidence of the benefit of renal biopsy. With the increasing use of imaging, an increasing number of small renal masses are being diagnosed. The majority of small renal masses are still treated with upfront definitive treatment, which results in overtreatment. Consequently, in patients in whom definitive treatment is being considered, biopsy of small renal masses can reduce overtreatment, cost, and most important, treatment-related morbidity.

Arthur McPhee, MD, of Glasgow Royal Infirmary, UK, explained that the incidence of small renal masses has been rising over the past decade, in keeping with the global increasing incidence in renal cell carcinoma seen over past decades. Studies have shown that 20–30% of small renal masses are benign, yet are unable to reliably distinguish between benign and malignant disease radiologically. Renal biopsy has been established as safe and reliable for obtaining information on the pretreatment histology of renal masses. Adoption by the urological community as a standard approach to guiding treatment, how- ever, remains low, as available evidence was in high-volume centres.

Patients who underwent biopsy of small renal masses between 2013 and 2016 were identified using a prospectively maintained electronic patient record system and a pathol- ogy database. Diagnostic and concordance rates were presented as proportions. A total of 208 biopsied small renal masses were included in the analysis and comparison with other high-volume centres. Of biopsied masses, the initial biopsy was diagnostic in 88% (n=184) of cases, of which 16.43 (n=34) were found to be benign. Only one patient experienced an adverse event (0.5%) and required a blood transfusion for postbiopsy bleeding. Concordance rates have improved over time.

PracticeUpdate Editorial Team

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY