Login to Access Video or Poster Abstract: MP67-20
Sources of Funding: CUA Scholarship Foundation, Kidney Cancer Research Network of Canada

Introduction

Although the majority of small renal masses (SRMs) are malignant, up to 30% are benign. Additionally, most malignant ones have low-metastatic potential. Therefore, their management has been associated with considerable overtreatment. To reduce the associated burden of care, renal tumor biopsies (RTBs) have been proposed as a safe, accurate and reliable alternative to identify the histology of SRMs prior to treatment. However, many urologists are still reluctant to adopt RTB; consequently, most SRMs are still being managed with upfront treatment. Thus, we designed a survey study with the objectives to better characterize the uptake of RTB in the management of SRMs and to identify the barriers to a more widespread adoption of RTB.

Methods

The link to a web-based survey was sent to all registered email addresses of members (n=767) of the Canadian Urological Association and the Quebec Urological Association in June 2016. The survey contained questions regarding the physicians practice patterns, RTB utilization and potential barriers of RTB. Chi-squared tests were used to assess for differences between specific groups of responders (per type of fellowship training).

Results

In total 223 members responded to the survey (response rate of 29%). Of these, 35 were excluded because of incomplete demographic responses or because they did not manage SRMs. Of the responders, 38 (20%) practiced in an academic center, 72 (38%) in a university-affiliated center and 78 (41%) in a community/rural hospital. Only a minority of responders (12%) requested RTB in >75% of cases while 53% never performed or performed RTB in less than 25% of cases. Physicians with urologic oncology fellowship-training were more likely to request a biopsy than endourologists (p=0.01) and physicians with no fellowship-training (p=0.003). The greatest management-related barrier was the perception that biopsy won&[prime]t alter management (36%) while the risk of obtaining a false-negative or a non-diagnostic biopsy was reported as the greatest pathology-related barrier to a more widespread adoption of RTB in the management of SRMs.

Conclusions

RTBs continue to be under-utilized in Canada with urologic oncology fellowship-trained physicians being more likely to request them than endourologists and physicians with no fellowship-training. Despite existing evidence that RTB is a safe and useful diagnostic test, concerns about its accuracy and its ability to change clinical practice continue to be barriers to its adoption. A knowledge translation strategy is needed to address these concerns and increase the use of RTB as the first step in managing patients with SRMs.

Funding

CUA Scholarship Foundation, Kidney Cancer Research Network of Canada