Clinicians’ Real World Perceptions of Pre-Nephrectomy Diagnostic Biopsy Performance as a Driver of Reduction in Unnecessary Surgeries in Renal Tumors
Main Article Content
Keywords
Kidney Cancer, Pre-nephrectomy biopsy, oncocytoma, chromophobe RCC, RCC, microRNA diagnostics
Abstract
Operative removal of oncocytomas is generally unnecessary, but not infrequent in the context of renal masses. The infrequent use of pre-nephrectomy biopsies is a function of historical limitations of histopathological differential diagnosis in this setting. Assessment of clinicians’ receptiveness to a novel molecular diagnostic approach to this challenge was undertaken by means of a survey vehicle administered to 102 practicing urologists and pathologists who met inclusion criteria related to their actual clinical activity. Survey results supported the previously reported observations on misdiagnosis with urologists’ reported rates of 25% inconclusive results, and an additional 17% disagree with the final surgical diagnosis. The self-reported rate of 9% for pre-operative biopsies was comparable to prior reports, but 39% of urologists who are not currently performing pre-operative biopsies expressed interest in introducing them into their practice for this purpose with an improved diagnostic. Almost all urologists (94%) felt it important not to resect benign oncocytomas and 62% indicated they would use a test which improved the ability to sub-type renal tumors pre-operatively. The level of performance benchmark of the unidentified prototypic microRNA-based diagnostic as reported previously in the literature was deemed sufficient to change care in these cases by 73%. Overall they predicted a 38% rate of biopsies and resulting increases in decisions to forgo nephrectomy or to perform only partial nephrectomy. Pathologists also expressed support for the use of this technology in the context of inadequate specimens and for improved sub-typing of these tumors in inconclusive cases.
References
2. Chow WH, DEvesa SS, Warren JL, Fraumeni JF. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628-31. Doi: http://dx.doi.org/10.1001/jama.281.17.1628
3. Devasa SS, Silverman DT, McLaughlin JK, Brown CC, Connelly RR, Fraumeni JF. Comparison of the descriptive epidemiology of urinary tract cancers. Cancer Causes Control. 1990;1(2):133-141. Doi: http://dx.doi.org/10.1007/BF00053164
4. Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology. 1998; 51(2):203-05. Doi: http://dx.doi.org/10.1016/S0090-4295(97)00506-2
5. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331-34. Doi: http://dx.doi.org/10.1093/jnci/djj362
6. Asnis-Alibozek AG, Fine MJ, Russo P, McLaughlin T, Farrelly EM, LaFrance N, Lowrance W. Cost of care for malignant and benign renal masses. AJMC 2013: 19(8) 617-24. [PMID: 24304211]
7. Oxley JD, Sullivan J, Mitchelmore A, Gillatt DA. Metastatic renal oncocytoma. J ClinPathol 2007;60:720–22. Doi: http://dx.doi.org/10.1136/jcp.2006.044198
8. Ng KL, Rajandram R, Morais C, Yap NY, Samaratunga H, Gobe GC, Wood ST. Differentiation of oncocytoma from chromophobe renal cell carcinoma (RCC): can novel molecular biomarkers help solve an old problem? J Clin Pathol. 2014;67(2):97-104. Doi: http://dx.doi.org/10.1136/jclinpath-2013-201895
9. Yusenko MV. Molecular pathology of chromophobe renal cell carcinoma: A review. Int J Urol 2010;17: 592–601. Doi: http://dx.doi.org/10.1111/j.1442-2042.2010.02558.x
10. Yusenko MV. Molecular pathology of renal oncocytoma: A review. Int J Urol 2010;17:602–12. Doi: http://dx.doi.org/10.1111/j.1442-2042.2010.02574.x
11. Calin GA, Croce CM. MicroRNA signatures in human cancers. Nat. Rev. Cancer 2006; 6 (11), 857e866. [PMID: 17060945]
12. Farazi TA, Spitzer JI, Morozov P, Tuschl T. miRNAs in human cancer. J. Pathol. 2011; 223 (2), 102e115. [PMID: 21125669].
13. Lu J, et al. MicroRNA expression profiles classify human cancers. Nature 2005; 435 (7043), 834e838. [PMID: 15944708]
14. Bentwich I. A postulated role for microRNA in cellular differentiation. Faseb J. 2005; 19 (8), 875e879. [PMID: 15923397]
15. Rosenfeld N, et al. MicroRNAs accurately identify cancer tissue origin. Nat. Biotechnol. 2008; 26 (4), 462e469. [PMID: 18362881]
16. Lebanony D, et al. Diagnostic assay based on hsa-miR-205 expression distinguishes squamous from nonsquamous non-small-cell lung carcinoma. J. Clin. Oncol. 2009; 27 (12), 2030e2037.
Doi: http://dx.doi.org/10.1200/JCO.2008.19.4134.
17. Barshack I, et al. MicroRNA expression differentiates between primary lung tumors and metastases to the lung. Pathol. Res. Pract. 2010; 206 (8), 578e584. Doi: http://dx.doi.org/10.1016/j.prp.2010.03.005.
18. Meiri E, et al. A Second-Generation MicroRNA-Based Assay for Diagnosing Tumor Tissue Origin. Oncologist 2012;17(6):801-12. Doi: http://dx.doi.org/10.1634/theoncologist.2011-0466
19. Pentheroudakis G, et al. Novel microRNA-based assay demonstrates 92% agreement with diagnosis based on clinicopathologic and management data in a cohort of patients with carcinoma of unknown primary. Mol Cancer June 2013 10;12(1):57 . Doi: http://dx.doi.org/10.1186/1476-4598-12-57.
20. Fridman E, et al. Accurate Molecular Classification of Renal Tumors Using MicroRNA Expression. J Mol Diagn. 2010 12(5):687-96.
Doi: http://dx.doi.org/10.2353/jmoldx.2010.090187
21. White, NM, Yousef GM. MicroRNAs: exploring a new dimension in the pathogenesis of kidney cancer. BMC Med. 2010; 8:65.
Doi: http://dx.doi.org/10.1186/1741-7015-8-65
22. Spector Y, Fridman E, Rosenwald S, Zilber S, Huang Y, Barshack I, Zion O, Mitchell H, Sanden M, Meiri E. Development and validation of a microRNA-based diagnostic assay for classification of renal cell carcinomas Molecular Oncology 2013; 7 (3) 732-8. Doi: http://dx.doi.org/10.1016/j.molonc.2013.03.002
23. Duchene DA, Lotan Y, Cadeddu JA, Sagalowsky AI, Koeneman KS. Histopathology of surgically managed renal tumors: analysis of a contemporary series. Urology 2003;62:827–30.
Doi: http://dx.doi.org/10.1016/S0090-4295(03)00658-7
24. Schachter LR, Cookson MS, Chang SS, Smith JA Jr, Dietrich MS, Jayaram G, Herrell SD. Second prize: frequency of benign renal cortical tumors and histologic subtypes based on size in a contemporary series: what to tell our patients. J Endourol 2007;21:819–23. Doi: http://dx.doi.org/10.1089/end.2006.9937
25. Wiatrowska, BA, Zakowski MF. Fine-needle aspiration biopsy of chromophobe renal cell carcinoma and oncocytoma: comparison of cytomorphologic features. Cancer (Cytopath) 1999: 87(3):161-7. [PMID: 10385448].
26. Liu J, Fanning CV. Can renal oncocytomas be distinguished from renal cell carcinoma on fine-needle aspiration specimens? A study of conventional smears in conjunction with ancillary studies. Cancer 2001;93(6):390–7. Doi: http://dx.doi.org/10.1002/cncr.10141
27. Allory Y, Bazille C, Vieillefond A, Molinie V, Cochand-Priollet B, Cussenot O, Callard P, Sibony M. Profiling and classification tree applied to renal epithelial tumours. Histopathology 2008; 52 (2), 158e166. [PMID: 18036175]
28. Huang WC, et al. Surveillance for the management of small renal masses: utilization and outcomes in a population-based cohort. Presented at: 4th Annual Genitourinary Cancers Symposium; February 14–16, 2013; Orlando, FL. Abstract 343.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.