Benign Pathology After Partial Nephrectomy More Common Than Thought

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New study finds a prevalence of benign pathologic findings after PN of 30.9%.
New study finds a prevalence of benign pathologic findings after PN of 30.9%.

Benign pathologic findings after partial nephrectomy (PN) is more prevalent than previously reported, new study findings published online ahead of print in JAMA Surgery suggest.

Earlier studies have found widely varying rates of benign pathologic diagnoses of 8% to 30%. In the current study, which looked at a nationally representative sample of 18,060 PN patients (mean age 57; 58.9% male) in Truven Health MarketScan Research Databases, Jae Heon Kim, MD, PhD, of Soonchunhyang University in Seoul, South Korea, and colleagues found benign pathology in 30.9% of patients overall, along with annual trends from 2008 to 2014 exceeding 30%.

On univariate analysis, preoperative magnetic resonance imaging (MRI) and renal mass biopsy were significantly associated with benign pathologic findings. Multivariable analysis revealed additional associated factors, including female sex, age older than 65 years, and using computed tomography (CT) alone for preoperative imaging. MRI alone or with ultrasound or any imaging modality with renal biopsy outperformed CT alone.

“Reducing the benign pathologic findings after PNx is an important issue considering the inherent surgical risk and surgery-related costs,” Dr Kim and colleagues team wrote. “Given our findings, it may be helpful for urologists to focus more on the extended role of MRI and the performance of biopsy to reduce benign pathologic findings after PNx.

“Recently, more high-quality evidence of the performance of biopsy in patients with suspicious small renal malignant tumors has been published, which provide further information about the possible final diagnosis in situations with equivocal clinical and radiographic findings.”

Among other limitations, the study lacked information on tumor size, pathologic stage, and surgical approach (including open, laparoscopic, or robotic surgery).

Reference

Kim JH, Li S, Khandwala Y, et al. Association of prevalence of benign pathologic findings after partial nephrectomy with preoperative imaging patterns in the United States from 2007 to 2014. JAMA Surg. DOI:10.1001/jamasurg.2018.4602 (Published online December 5, 2018)

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