Richard Patrick O, Martin Lisa, Lavallée Luke T, Violette Philippe D, Komisarenko Maria, Evans Andrew J, Jain Kunal, Jewett Michael A S, Finelli Antonio
Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du CHUS and the University of Sherbrooke, Sherbrooke, QC, Canada.
Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.
Can Urol Assoc J. 2018 Aug;12(8):260-266. doi: 10.5489/cuaj.5065. Epub 2018 Apr 6.
Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decision-making. However, many urologists are reluctant to use RTB as a standard of care. This study characterizes the current use of RTB in the management of SRMs and identifies barriers to a more widespread adoption.
A web-based survey was sent to members of the Canadian and Quebec Urological Associations who had registered email address (n=767) in June 2016. The survey examined physicians' practice patterns, RTB use, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents.
The response rate was 29% (n=223), of which 188 respondents were eligible. A minority of respondents (12%) perform RTB in >75% of cases, while 53% never perform or perform RTB in <25% of cases. Respondents with urological oncology fellowship training were more likely to request a biopsy than their colleagues without such training. The most frequent management-related reason for not using routine RTB was a belief that biopsy won't alter management, while the most frequent pathology-related reason was the risk of obtaining a false-negative or a non-diagnostic biopsy.
Adoption of RTBs remains low in Canada. Concerns about the accuracy of RTB and its ability to change clinical practice are the largest barriers to adoption. A knowledge translation strategy is needed to address these concerns. Future studies are also required in order to define where RTB is most valuable and how to best to implement it.
肾肿瘤活检（RTB）可在治疗决策前提供小肾肿块（SRM）的组织学信息。然而，许多泌尿科医生不愿将RTB作为标准治疗方法。本研究描述了RTB在SRM管理中的当前应用情况，并确定了其更广泛应用的障碍。
向加拿大和魁北克泌尿外科学会2016年6月注册了电子邮件地址的会员（n = 767）发送了基于网络的调查问卷。该调查考察了医生的执业模式、RTB的使用情况以及RTB的潜在障碍。采用卡方检验评估受访者之间的差异。
回复率为29%（n = 223），其中188名受访者符合条件。少数受访者（12%）在超过75%的病例中进行RTB，而53%的受访者从不进行或在不到25%的病例中进行RTB。接受过泌尿肿瘤学 fellowship培训的受访者比未接受此类培训的同事更有可能要求进行活检。不使用常规RTB最常见的与管理相关的原因是认为活检不会改变治疗方案，而最常见的与病理相关的原因是获得假阴性或非诊断性活检的风险。
加拿大RTB的采用率仍然很低。对RTB准确性及其改变临床实践能力的担忧是采用率低的最大障碍。需要一种知识转化策略来解决这些担忧。未来还需要开展研究，以确定RTB最有价值的领域以及如何最好地实施它。
