Purpose: Owing to uncertainty on best management, a subset of patients with small renal masses suspicious for kidney cancer experience elevated decisional conflict. We hypothesize that pathologic information from renal mass biopsy (RMB) may improve patient decision-making. In this study, we evaluate the impact of RMB on decisional conflict for patients with clinical T1 renal masses.
Materials and methods: A comparative, nonrandomized clinical trial was performed at a large tertiary cancer center. Patients with new clinical T1 renal masses were self-assigned to standard-of-care biopsy. We used difference-in-difference (DiD) analyses to assess change in decisional conflict scale by receipt of RMB.
Results: Among 250 participants, 25% underwent biopsy during the initial decision-making period before definitive intervention. Biopsy was more common for patients with masses > 4 cm vs 0 to 2 cm (prevalence ratios [PR] 2.41, 95% CI: 1.20-4.82, P = .01), high nephrometry score vs low (PR 2.13, 95% CI: 1.13-4.01, P = .02), and higher maximizer-minimizer score (PR 1.02, 95% CI: 1.00-1.05, P = .04). On adjusted DiD analysis, there was a small, nonsignificant reduction in decisional conflict for subjects undergoing biopsy vs no biopsy (-2.78, 95% CI: -7.18 to 1.45, P = .20). Among subgroups, DiD by biopsy was large for total decisional conflict score in patients who did not see an outside urologist (-6.22) and patients reporting lower communication scores (-8.24).
Conclusions: Though RMB did not significantly decrease decisional conflict in all patients, biopsy reduced decisional conflict in certain patient subsets, demonstrating the importance of further investigating how to better support patients after renal mass diagnosis.
Keywords: core needle biopsy; renal cell carcinoma; shared decision-making.