Introduction: Recommending surgical excision of a neoplasm in the absence of a tissue diagnosis is unique to renal masses, despite data showing 20-40% of renal tumors are found to be benign. Although recent literature has demonstrated renal mass biopsy (RMB) to be safe and diagnostically accurate, physicians continue to cite questionable clinical utility as a reason to avoid pre-operative RMB. We aimed to prospectively evaluate the utility of RMB in shared decision-making for renal mass treatment.
Methods: This was an IRB-approved prospective observational cohort pilot study of all patients referred for RMB from Oct 2019 – Oct 2021. RMB referral was at physician discretion. Patients and physicians completed pre- and post-RMB questionnaires. The pre-RMB physician questionnaire assessed treatment recommendation and anticipated usefulness of RMB data. Pre-RMB patient questionnaires assessed patient attitudes towards RMB, treatment preference, and decisional conflict. Post-RMB surveys assessed treatment recommendations and perceived utility of RMB data in both patient and physician decision making.
Results: 22 patients, 59% male, mean age 66 years (SD 14.5), mean renal tumor size 3.1cm (SD 1.4) were included. 5 patients were lost to follow-up (3 pre-RMB and 2 post-RMB). Pre-RMB, 100% of patients stated that “information from a RMB will help me decide how to treat my kidney tumor.” 64% of patients were less than willing (score = 5/10) to accept a treatment without RMB and 91% were more than willing to pursue a RMB (score > 5/10). 45% of patients were unsure of their treatment preference pre-RMB, and 25% who had a treatment preference were “not clear if this was the best choice.” Post-RMB, 86% of patients stated that the RMB results helped “[them] make a decision about treatment”, 92% rated the RMB as useful (score > 5/10), and 71% selected their ultimate treatment preference at least in part because of their RMB result. Of patients who were unsure of best treatment choice pre-RMB, 86% felt clear in their decision post-RMB and 100% were “glad they had a RMB.” Post-RMB, 57% of patients and 40% of physicians selected a different treatment preference. Discordance between patient and physician treatment preference was observed in 81% of cases pre-RMB, but only in 25% of cases post-RMB.
Conclusions: Discordance between patient and physician treatment preference for renal masses is higher in the absence of RMB data. Patients are willing to undergo RMB and RMB data can increase patient confidence and comfort in a shared decision-making approach for renal mass treatment.