Real world outcomes of biopsy‐proven oncocytic neoplasm of the kidney managed by surveillance

Abstract

Objectives To evaluate outcomes of patients diagnosed with oncocytic renal neoplasms on routine renal mass biopsy and to describe the natural history of these tumours when managed with surveillance as opposed to immediate intervention. To report disease‐specific survival. Patients and methods Patients were identified from a retrospective review of pathology databases from three tertiary referral centres that utilise renal mass biopsy in routine clinical practice. All patients with biopsy‐proven oncocytic tumours were included and a retrospective review of online patient records was undertaken. Results There were 184 biopsy‐proven oncocytic renal neoplasms identified in 172 patients. There were two biopsy complications (both pneumothorax, Clavien–Dindo Grade I). Of these lesions, 135 were reported as oncocytomas or oncocytic renal neoplasms that were not further classified and 37 were reported as chromophobe carcinoma (ChRCC). The median age at diagnosis was 70 (33–88). The average tumour diameter at diagnosis was 33 mm. One hundred seven tumours were initially managed with surveillance (including 13 ChRCC) with a minimum follow‐up of 6 months and a median of 39 months (6–144) whereas 49 patients underwent immediate treatment. The mean growth rate across all oncocytic renal neoplasms managed by surveillance was 3 mm/year. There was no statistically significant difference in growth rates between oncocytic renal neoplasms and ChRCC. Thirteen patients with oncocytic renal neoplasms initially managed by surveillance moved on to an active management strategy during follow‐up. The clinical indication given for a change from surveillance was tumour growth in 12 cases and patient choice in 1 case. Where definitive pathology was available, there was 85% concordance with the biopsy. There were no cases of development of metastatic disease or disease‐related morbidity or mortality during the study. Conclusions This multicentre retrospective cohort study supports the hypothesis that selected biopsy‐proven oncocytic renal neoplasms can be safely managed with surveillance in the medium term. Routine renal mass biopsy may reduce surgery for benign or indolent renal tumours and the potential associated morbidity for these patients.

Seasonal events and journal milestones

“…Rodger et al [5] addressed the key question in renal neoplasms as to whether or not a biopsy‐proven oncocytoma can go on active surveillance without disease progression. In a biopsy‐proven cohort of 172 patients (184 tumours), they had 117 go on to surveillance without disease progression and 49 treated with 85% final pathology concordance.…”

“…From reviewing cases as our department's safety officer, I would add that sometimes the symptoms emerge before the images are abnormal-so repeat imaging if clinical suspicion persists. Rodger et al [5] addressed the key question in renal neoplasms as to whether or not a biopsy-proven oncocytoma can go on active surveillance without disease progression. In a biopsy-proven cohort of 172 patients (184 tumours), they had 117 go on to surveillance without disease progression and 49 treated with 85% final pathology concordance.…”

Machine Learning Integrating 99mTc Sestamibi SPECT/CT and Radiomics Data Achieves Optimal Characterization of Renal Oncocytic Tumors

“…Kidney tumors negative on 99m Tc Sestamibi SPECT/CT examination could be managed with surgery. In contrast, those that are positive could be followed by an active surveillance program [16], avoiding unnecessary surgery [17].…”