Page 1 - Role of renal mass biopsy in the management of kidney cancer: KCRNC

KCRNC CONSENSUS STATEMENT

Kidney Cancer Research Network of Canada (KCRNC) consensus

statement on the role of renal mass biopsy in the management of

kidney cancer

Luke T. Lavallée, MDCM, MSc, FRCSC ;Kristen McAlpine, MD ; Anil Kapoor, MD, FRCSC ;
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Frédéric Pouliot, MD, PhD, FRCSC ; Ross Mason, MD, MSc, FRCSC ; Philippe D. Violette, MD, FRCSC ;
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Rahul K. Bansal, MD, MCh, FRCSC; Patrick O. Richard, MD, MSc, FRCSC; Pierre I. Karakiewicz, MD, MPH, FRCSC;
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Bimal Bhindi, MD, CM, MSc, FRCSC ; Ranjena Maloni ; Stephen Pautler, MD, FRCSC ;
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Jean-Baptiste Lattouf, MD, FRCSC ; Wassim Kassouf, MD, CM, FRCSC ; Simon Tanguay, MD, FRCSC ;
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Alan So, MD, FRCSC ; Ricardo A. Rendon, MD, MSc, FRCSC ; Rodney H. Breau, MD, MSc, FRCSC 1,2
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1 Division of Urology, University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Departments of Surgery (Urology) and Oncology, McMaster
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University, Hamilton, ON, Canada; Department of Surgery, Division of Urology, Université Laval, Quebec City, QC, Canada; Department of Urology, Dalhousie University, Halifax, NS, Canada; Departments
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of Health Research Methods Evidence and Impact and Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; Division of Urology,
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Université Sherbrooke, Sherbrooke, QC, Canada; Department of Surgery, Université de Montréal, Montreal, QC, Canada; Department of Surgery, Section of Urology, University of Calgary, Calgary, AB,
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Canada; Kidney Cancer Research Network of Canada; Department of Surgery, Division of Urology, Western University, London, ON, Canada; Department of Surgery, Division of Urology, McGill University,
Montreal, QC, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Cite as: Can Urol Assoc J 2019;13(12):377-83. http://dx.doi.org/10.5489/cuaj.6176 The scientific literature available for this consensus state-
ment was of low-to-moderate-quality. The evidence reported
on renal mass biopsy is predominantly comprised of retro-
Published online September 17, 2019 spective cohort series of patients managed at high-volume
centers. Recently, a systematic review and meta-analysis
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of renal mass biopsy was published, which summarizes the
Introduction best available evidence on the diagnostic ability and safety
of this test. 7
The pervasive use of diagnostic imaging has led to an
increase in the incidental detection of small renal masses. 1-4 Management options for renal masses
The assessment and management of a patient with a renal
mass should vary based on mass characteristics and on the Several factors should be considered during consultation
individual patient’s health and personal preferences. of a patient referred with a renal mass. Individual patient
Renal mass biopsy is a diagnostic test used to obtain tissue considerations include age, sex, comorbidities, medica-
from a suspicious mass in the kidney. Several patient fac- tions, and performance status, as these factors are associated
tors and mass characteristics should be considered to deter- with the probability of renal malignancy, the probability of
mine when a biopsy is a useful test for a patient. Recently, biopsy/treatment-related adverse events, and/or the patient’s
there have been a number of published series on renal mass overall life expectancy. Mass characteristics that should be
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biopsy that discuss which patient populations benefit from considered include size, location, appearance on imaging,
this diagnostic test. 5-7 number of masses, and presence of cystic components, as
The objectives of this consensus statement are: 1) to these factors are associated with probability of malignancy
review and synthesize the evidence on renal mass biopsy; and the diagnostic performance of biopsy. Most import -
and 2) to highlight important concepts and provide guid- antly, patient preferences and values must be considered
ance regarding the role of renal mass biopsy. The statements to facilitate shared decision-making about diagnostic tests
contained in this report were based on the best available and management.
evidence and developed by expert consensus. It is expected Small renal masses are lesions in the kidney that are typ-
that these statements will be used to guide care in Canada ically defined as <4 cm in diameter. Although the major-
and that some variability in practice will exist for individual ity of these masses are malignant, many malignant kidney
patients and regional practice variation. masses do not harbor aggressive histology (low-grade, low
CUAJ • December 2019 • Volume 13, Issue 12 377
© 2019 Canadian Urological Association