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Socioeconomic Factors, Urological Epidemiology and Practice Patterns
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SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS Percutaneous Needle Biopsy for Indeterminate Renal Masses: A National Survey of UK Consultant Urologists A. A. Khan, I. S. Shergill, S. Quereshi, M. Arya, M. T. Vandal and S. S. Gujral, Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom BMC Urol 2007; 7: 10. Background: The use of percutaneous needle biopsy in the evaluation of indeterminate renal masses is controversial and its role in management remains largely unclear. We set to establish current practice on this issue in UK urology departments. Methods: We conducted a national questionnaire survey of all consultant urologists in the UK, to establish current practice and attitudes towards percutaneous needle biopsy in the management of indeterminate renal masses. Results: 139 (43%) consultant urologists never use biopsy, whereas 111 (34%) always employ it for the diagnosis of indeterminate renal masses. 75 (23%) urologists use biopsy only for a selected patient group. Mass in a solitary kidney, bilateral renal masses and a past history of non-renal cancer were the main indications for use of percutaneous biopsy. The risk of false negative results and biopsy not changing the eventual management of their patients were the commonest reasons not to perform biopsy. Conclusion: There is a wide and varied practice amongst UK Consultant Urologists in the use of percutaneous biopsy as part of the management of indeterminate renal masses. The majority of urologists believe biopsy confers no benefit. However there is a need to clarify this issue in the wake of recent published evidence as biopsy results may provide critical information for patients with renal masses in a significant majority. It not only differentiates benign from malignant tissue but can also help in deciding the management option for patients undergoing minimally invasive treatments. Editorial Comment: Biopsy of indeterminate renal masses is a somewhat controversial topic. Traditionally, this evaluation has been a rarely recommended diagnostic test because of concern with false-negative results due to sampling error. However, in the era of targeted minimally invasive therapy the renal biopsy may become a more important part of our diagnostic armamentarium. Currently, in the United Kingdom 34% of consultant urologists always use percutaneous renal biopsy for the diagnosis of indeterminate masses. This proportion is much higher than I would have expected, and I suspect that this number will increase if use of minimally invasive therapies for renal masses continues to increase. David F. Penson, M.D., M.P.H.
IMAGING Renal Pseudotumors S. Bhatt, G. MacLennan and V. Dogra, Department of Radiology, University of Rochester School of Medicine and Dentistry, Rochester, New York AJR Am J Roentgenol 2007; 188: 1380 –1387. Objective: Renal cell carcinoma is the most common malignant tumor to involve the kidneys; however, a number of other entities– called renal pseudotumors–may mimic renal neoplasms on imaging. This article presents the imaging features and pathologic correlation of some of the common and uncommon renal pseudomasses. Conclusion: Many renal lesions look similar to renal cell carcinoma on radiologic imaging. The imaging features of renal pseudotumors presented in this article will help radiologists to identify them and to triage these patients for appropriate management. Editorial Comment: This article is a pictorial essay discussing renal pseudotumors, with multiple excellent examples. The initial portion of the article discusses developmental abnormalities, including column of Bertin, fetal lobulation, splenorenal fusion and cross-fused renal ectopia. The second portion includes infectious etiologies such as abscess, pyelonephritis and scarred kidney (from prior infection or reflux nephropathy) where focal areas of preserved or hypertrophied renal parenchyma may appear mass-like. The final section is about granulomatous processes such as xanthogranulomatous pyelonephritis and sarcoidosis. This pictorial
SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS Percutaneous Needle Biopsy for Indeterminate Renal Masses: A National Survey of UK Consultant Urologists A. A. Khan, I. S. Shergill, S. Quereshi, M. Arya, M. T. Vandal and S. S. Gujral, Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom BMC Urol 2007; 7: 10. Background: The use of percutaneous needle biopsy in the evaluation of indeterminate renal masses is controversial and its role in management remains largely unclear. We set to establish current practice on this issue in UK urology departments. Methods: We conducted a national questionnaire survey of all consultant urologists in the UK, to establish current practice and attitudes towards percutaneous needle biopsy in the management of indeterminate renal masses. Results: 139 (43%) consultant urologists never use biopsy, whereas 111 (34%) always employ it for the diagnosis of indeterminate renal masses. 75 (23%) urologists use biopsy only for a selected patient group. Mass in a solitary kidney, bilateral renal masses and a past history of non-renal cancer were the main indications for use of percutaneous biopsy. The risk of false negative results and biopsy not changing the eventual management of their patients were the commonest reasons not to perform biopsy. Conclusion: There is a wide and varied practice amongst UK Consultant Urologists in the use of percutaneous biopsy as part of the management of indeterminate renal masses. The majority of urologists believe biopsy confers no benefit. However there is a need to clarify this issue in the wake of recent published evidence as biopsy results may provide critical information for patients with renal masses in a significant majority. It not only differentiates benign from malignant tissue but can also help in deciding the management option for patients undergoing minimally invasive treatments. Editorial Comment: Biopsy of indeterminate renal masses is a somewhat controversial topic. Traditionally, this evaluation has been a rarely recommended diagnostic test because of concern with false-negative results due to sampling error. However, in the era of targeted minimally invasive therapy the renal biopsy may become a more important part of our diagnostic armamentarium. Currently, in the United Kingdom 34% of consultant urologists always use percutaneous renal biopsy for the diagnosis of indeterminate masses. This proportion is much higher than I would have expected, and I suspect that this number will increase if use of minimally invasive therapies for renal masses continues to increase. David F. Penson, M.D., M.P.H.
IMAGING Renal Pseudotumors S. Bhatt, G. MacLennan and V. Dogra, Department of Radiology, University of Rochester School of Medicine and Dentistry, Rochester, New York AJR Am J Roentgenol 2007; 188: 1380 –1387. Objective: Renal cell carcinoma is the most common malignant tumor to involve the kidneys; however, a number of other entities– called renal pseudotumors–may mimic renal neoplasms on imaging. This article presents the imaging features and pathologic correlation of some of the common and uncommon renal pseudomasses. Conclusion: Many renal lesions look similar to renal cell carcinoma on radiologic imaging. The imaging features of renal pseudotumors presented in this article will help radiologists to identify them and to triage these patients for appropriate management. Editorial Comment: This article is a pictorial essay discussing renal pseudotumors, with multiple excellent examples. The initial portion of the article discusses developmental abnormalities, including column of Bertin, fetal lobulation, splenorenal fusion and cross-fused renal ectopia. The second portion includes infectious etiologies such as abscess, pyelonephritis and scarred kidney (from prior infection or reflux nephropathy) where focal areas of preserved or hypertrophied renal parenchyma may appear mass-like. The final section is about granulomatous processes such as xanthogranulomatous pyelonephritis and sarcoidosis. This pictorial