8 / 32
European Cancer
Congress 2017
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.
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.
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.
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.
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.
PracticeUpdate Editorial Team
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.
27–30 JANUARY 2017 | AMSTERDAM, THE NETHERLANDS
CONFERENCE COVERAGE
8
PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY