MP80-15 ROUTINE BIOPSY OF CT1 RENAL MASSES: POTENTIAL COST SAVINGS AND MORBIDITY AVOIDANCE (2020)

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP80)1 Apr 2020MP80-15 ROUTINE BIOPSY OF CT1 RENAL MASSES: POTENTIAL COST SAVINGS AND MORBIDITY AVOIDANCE Abhishek Srivastava*, Robert N. Uzzo, Eric Cho, Alex Grieco, Selma Masic, David Y.T. Chen, Rosalia Viterbo, Richard Greenberg, Marc Smaldone, Alexander Kutikov, and Robert G. Uzzo Abhishek Srivastava*Abhishek Srivastava* More articles by this author , Robert N. UzzoRobert N. Uzzo More articles by this author , Eric ChoEric Cho More articles by this author , Alex GriecoAlex Grieco More articles by this author , Selma MasicSelma Masic More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000972.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal mass biopsy (RMB) has not been adopted widely by urologists for the evaluation of small renal mass (SRM) before considering surgical intervention due to concerns for safety, efficacy, and its perceived lack of consequence on management decisions. We simulated the potential cost savings and morbidity avoidance at our high-volume tertiary care cancer center if we had performed RMB on all cT1 renal masses undergoing robotic-assisted partial nephrectomy (RAPN). METHODS: We evaluated our prospectively collected database of n=920 consecutive RAPN for cT1 renal masses. Final pathology was classified as benign (AML, oncocytoma); very low risk (chRCC); low risk (pRCC type 1, ccRCC low grade), and high risk (ccRCC high grade, pRCC type 2, or other). We compared clinicopathologic variables and morbidity (Clavien I-V) events between these four final pathology risk groups. We calculated FY 19 total median direct cost for RAPN. We assessed our institutional cost, complications and outcomes of RMB for cT1 (n=429) to compare baseline risks at our institution. We defined four clinical scenarios where routine RMB could have delayed and/or avoided intervention: 1) Benign biopsy in all patients; 2) Benign or very low-risk biopsy in patients >65; 3) Benign, very low or low-risk biopsy in patients >70; 4) Benign, very low or low risk in any patient with eGFR <44 OR ASA ≥3 OR CCI ≥2. RESULTS: In our RAPN patients, 174 (18.9%), 62 (7%), 383 (42%) and 301 (33%) were benign, very low, low and high-risk tumors. In our RMB patients, 120 (27.9%), 17 (3.9%), 240 (55.9%), 52 (12.1%) were benign, very low, low and high-risk tumors, and there were no complications. Median total direct cost for RAPN was $6955/case compared to $1312/case for RMB. Under our proposed clinical scenarios, RMB in all 920 cT1 SRMs could have potentially saved a net cost of $1.5 million and avoided n=38 Clavien graded complications, 6 readmissions, 3 transfusions and 2 returns to the OR (Table 1). CONCLUSIONS: RMB before intervention under the proposed clinical scenarios may result in potential cost-saving and complication avoidance and should be strongly considered before surgical intervention in cT1 renal masses. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1231-e1232 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Srivastava* More articles by this author Robert N. Uzzo More articles by this author Eric Cho More articles by this author Alex Grieco More articles by this author Selma Masic More articles by this author David Y.T. Chen More articles by this author Rosalia Viterbo More articles by this author Richard Greenberg More articles by this author Marc Smaldone More articles by this author Alexander Kutikov More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement PDF downloadLoading ...