Preoperatively Misclassified, Surgically Removed Benign Renal Masses: A Systematic Review of Surgical Series and United States Population Level Burden Estimate

No AccessJournal of UrologyAdult Urology1 Jan 2015Preoperatively Misclassified, Surgically Removed Benign Renal Masses: A Systematic Review of Surgical Series and United States Population Level Burden Estimate David C. Johnson, Josip Vukina, Angela B. Smith, Anne-Marie Meyer, Stephanie B. Wheeler, Tzy-Mey Kuo, Hung-Jui Tan, Michael E. Woods, Mathew C. Raynor, Eric M. Wallen, Raj S. Pruthi, and Matthew E. Nielsen David C. JohnsonDavid C. Johnson Department of Urology, University of North Carolina, Chapel Hill, North Carolina , Josip VukinaJosip Vukina Department of Urology, University of North Carolina, Chapel Hill, North Carolina , Angela B. SmithAngela B. Smith Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Anne-Marie MeyerAnne-Marie Meyer Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Stephanie B. WheelerStephanie B. Wheeler Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Tzy-Mey KuoTzy-Mey Kuo Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Hung-Jui TanHung-Jui Tan Department of Urology, Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, California , Michael E. WoodsMichael E. Woods Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Mathew C. RaynorMathew C. Raynor Department of Urology, University of North Carolina, Chapel Hill, North Carolina , Eric M. WallenEric M. Wallen Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , Raj S. PruthiRaj S. Pruthi Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina , and Matthew E. NielsenMatthew E. Nielsen University of North Carolina, Chapel Hill, North Carolina View All Author Informationhttps://doi.org/10.1016/j.juro.2014.07.102AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A significant proportion of renal masses removed for suspected malignancy are histologically benign with the probability inversely proportional to lesion size. To our knowledge the number of preoperatively misclassified benign renal masses treated with nephrectomy is currently unknown. Given the increasing incidence and decreasing average size of renal cell carcinoma, this burden is likely increasing. We estimated the population level burden of surgically removed, preoperatively misclassified benign renal masses in the United States. Materials and Methods: We systematically reviewed the literature for studies of pathological findings of renal masses removed for suspected renal cell carcinoma based on preoperative imaging through July 1, 2014. We excluded studies that did not describe benign pathology and with masses not stratified by size, and in which pathology results were based on biopsy. SEER data were queried for the incidence of surgically removed renal cell carcinomas in 2000 to 2009. Results: A total of 19 studies of tumor pathology based on size met criteria for review. Pooled estimates of the proportion of benign histology in our primary analysis (American studies only and 1 cm increments) were 40.4%, 20.9%, 19.6%, 17.2%, 9.2% and 6.4% for tumors less than 1, 1 to less than 2, 2 to less than 3, 3 to less than 4, 4 to 7 and greater than 7, respectively. The estimated number of surgically resected benign renal masses in the United States from 2000 to 2009 increased by 82% from 3,098 to 5,624. Conclusions: These estimates suggest that the population level burden of preoperatively misclassified benign renal masses is substantial and increasing rapidly, paralleling increases in surgically resected small renal cell carcinoma. This study illustrates an important and to our knowledge previously unstudied dimension of overtreatment that is not directly quantified in contemporary surveillance data. References 1 SEER Cancer Statistics Review, 1975–2007, updated 2010. Available at http://seer.cancer.gov/csr/1975_2007/. Accessed July 22, 2014. Google Scholar 2 : Rising incidence of renal cell cancer in the United States. JAMA1999; 281: 1628. Crossref, Medline, Google Scholar 3 : Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol2002; 167: 57. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byButaney M, Wilder S, Patel A, Qi J, Mirza M, Noyes S, Johnson A, Van Til M, Jafri S, Ginsburg K, Rogers C and Lane B (2023) Initial Management of Indeterminate Renal Lesions in a Statewide Collaborative: A MUSIC-KIDNEY AnalysisJournal of Urology, VOL. 210, NO. 1, (79-87), Online publication date: 1-Jul-2023.Su Z, Patel H, Huang M, Alam R, Cheaib J, Pavlovich C, Allaf M and Pierorazio P (2022) Active Surveillance versus Immediate Intervention for Small Renal Masses: A Cost-Effectiveness and Clinical Decision AnalysisJournal of Urology, VOL. 208, NO. 4, (794-803), Online publication date: 1-Oct-2022.Uhlig A, Lenis A, Wang X and Shuch B (2021) Sequencing of Renal Mass Biopsy and Ablation: Results from the National Cancer DatabaseUrology Practice, VOL. 8, NO. 5, (555-564), Online publication date: 1-Sep-2021.Laguna M (2019) Re: Diagnostic Needle Biopsies in Renal Masses: Patient and Physician PerspectivesJournal of Urology, VOL. 202, NO. 1, (28-29), Online publication date: 1-Jul-2019.Laguna M (2018) Re: Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass HistologyJournal of Urology, VOL. 200, NO. 6, (1161-1162), Online publication date: 1-Dec-2018.Zhao C, Tolkach Y, Schmidt D, Kristiansen G, Müller S and Ellinger J (2017) 5′-tRNA Halves are Dysregulated in Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 199, NO. 2, (378-383), Online publication date: 1-Feb-2018.Wolf J (2017) Biopsy of Small Renal Masses Should be Routinely Performed before Deciding TreatmentJournal of Urology, VOL. 198, NO. 4, (757-759), Online publication date: 1-Oct-2017.Laviana A, Kundavaram C, Tan H, Burke M, Niedzwiecki D, Lee R and Hu J (2016) Determining the True Costs of Treating Small Renal Masses Using Time Driven, Activity Based CostingUrology Practice, VOL. 3, NO. 3, (180-186), Online publication date: 1-May-2016.Patel H, Johnson M, Pierorazio P, Sozio S, Sharma R, Iyoha E, Bass E and Allaf M (2016) Diagnostic Accuracy and Risks of Biopsy in the Diagnosis of a Renal Mass Suspicious for Localized Renal Cell Carcinoma: Systematic Review of the LiteratureJournal of Urology, VOL. 195, NO. 5, (1340-1347), Online publication date: 1-May-2016. Volume 193 Issue 1 January 2015 Page: 30-35 Supplementary Materials Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordskidneycarcinomarenal cellneoplasmsdiagnostic errorsSEER programAcknowledgmentsMickey Kalavsky assisted with the figures. Karen Crowell assisted with the literature review.Metrics Author Information David C. Johnson Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author Josip Vukina Department of Urology, University of North Carolina, Chapel Hill, North Carolina More articles by this author Angela B. Smith Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Anne-Marie Meyer Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Stephanie B. Wheeler Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Tzy-Mey Kuo Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Hung-Jui Tan Department of Urology, Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, California More articles by this author Michael E. Woods Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina Financial interest and/or other relationship with LBS LabCorp. More articles by this author Mathew C. Raynor Department of Urology, University of North Carolina, Chapel Hill, North Carolina Financial interest and/or other relationship with Intuitive Surgical and Teleflex Medical. More articles by this author Eric M. Wallen Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Raj S. Pruthi Department of Urology, University of North Carolina, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina More articles by this author Matthew E. Nielsen University of North Carolina, Chapel Hill, North Carolina Financial interest and/or other relationship with Best Doctors and American College of Physicians. More articles by this author Expand All Advertisement PDF downloadLoading ...