Dados do Trabalho

Título

SMALL RENAL MASS MANAGEMENT IN LATIN AMERICA: WHY BIOPSY IS NOT STANDARD OF CARE?

Introdução e Objetivo

Renal mass biopsy (RMB) is not routinely performed for the management of small renal masses (SRM), despite a high rate of up to 20% incidental nephrectomy (benign histopathology). Previous surveys in the U.S. have shown that the most cited reasons for not doing a RMB are, no alteration in management, accuracy of RMB, complications, and tract-seeding; however, all those reasons have been dispelled in recent literature. This study aimed to assess the rate of preoperative RMB for SRM in Latin America and to identify reasons for not performing it routinely.

Método

In this study, a survey was distributed through the Sociedade Brasileira de Urologia, Confederación Americana de Urología, Sociedad Argentina de Urología, Sociedad Chilena de Urología, and Sociedad Colombiana de Urología. The survey consisted of three parts: demographic information of the urologists; recommendation of RMB; and management of five clinical cases chosen for scenarios where a RMB could be considered within AUA guidelines based on patient age, case complexity, and location of the mass. 

Resultados

A total of 179 urologists completed the survey: 75 from Brazil, 53 from Chile, 30 from Colombia, 18 from Argentina, and 1 from Guatemala. Most (57%) were attending general urologists; 24% were urologic oncologists, 5% were endourologists and 12% were residents or fellows in training. The survey included urologists from academic practice (25%), private practice (27%), or both (49%). Most (82%) would recommend RMB in less than 10% of the cases (or never), the most common reasons being no alteration in management (46%), risk of false negative results (45%), absence of benefits (34%), and complication rate (24%). Less than 4% recommended RMB in the majority (>50%) of his SRM cases (Table 1). In the clinical cases, a preoperatory RMB was only recommended by 2%, 8%, 6%, 12%, and 4% (for each case) of the urologists, respectively (Table 2).

Conclusão

The underperformance of RMB for SRM in Latina America, as well as the reasons cited by Latina American urologists for that paucity, is similar to U.S. urologists. The rationale for avoiding RMB has been dismissed in recent studies, demonstrating a need for updated guidelines to educate urologists on the role of RMB for SRM.