Dutta Rahul, Okhunov Zhamshid, Vernez Simone L, Kaler Kamaljot, Gulati Anjalie T, Youssef Ramy F, Nelson Kari, Lotan Yair, Landman Jaime
1 Department of Urology, University of California , Irvine, Orange, California.
2 Department of Radiology, University of California , Irvine, Orange, California.
J Endourol. 2016 May;30 Suppl 1(Suppl 1):S28-33. doi: 10.1089/end.2016.0015. Epub 2016 Mar 31.
To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs).
We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology.
A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were $3449, $3280, and $1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologist's and radiologist's professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were $4598, $4470, and $2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001).
For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.
比较超声引导下医院内（UGHB）、CT引导下医院内（CTG）以及超声引导下门诊（UGOB）经皮肾穿刺活检（PRB）用于小肾肿块（SRM）的相关成本。
我们回顾性分析了2012年5月至2015年9月在我院接受SRM的PRB患者的人口统计学资料、肿瘤特征、R.E.N.A.L.肾测量评分及成本数据。成本数据包括设备成本、专业费用和病理学费用，分别来自泌尿外科、放射科和病理科。
我们的分析共纳入78例患者：UGHB组19例、CTG组31例、UGOB组28例。三组患者在年龄、性别分布或肿瘤大小方面无差异（p值分别为0.131、0.241和0.603）。UGOB组肿瘤的R.E.N.A.L.肾测量评分较低（p = 0.008）。UGHB组、CTG组和UGOB组的非诊断率无差异[分别为4例（21%）、5例（16%）和6例（21%）]（p = 0.852）。UGHB组、CTG组和UGOB组最终采用的肿瘤治疗策略无差异（p = 0.447）。UGHB组、CTG组和UGOB组活检的并发症分别为0例、2例（6%）和0例。UGHB组、CTG组和UGOB组PRB的设备总成本分别为3449美元、3280美元和1056美元（p < 0.0001）。泌尿外科医生和放射科医生的专业费用无差异（p = 0.066）。UGHB组、CTG组和UGOB组肾活检的总成本（包括设备成本、病理费用和专业费用）分别为4598美元、4470美元和2129美元（p < 0.0001）。
对于部分解剖结构不复杂、外生性且位于后方的肿瘤患者，UGOB PRB的诊断率和并发症发生率相当，且比UGHB或CTG肾活检的成本效益显著更高。
