Bernstein Darryl E, Warren Hannah, Santiapillai Joseph, Fox Geraldine, Wildgoose William H, Stewart Grant D, Armitage Jim, Le Roux Pieter, Keeley Frank X, Campain Nicholas, Challacombe Ben, Warburton Hazel, Palumbo Carlotta, Campi Riccardo, Muselaers Stjin H J, Walkden Miles, Bandula Steve, Yu Dominic, Gonsalves Michael, Tran-Dang My-Anh, Etessami Nazanin, Oliveira Pedro, Calio Anna, El-Sheikh Soha, Wah Tze, Bex Axel, Barod Ravi, Gurusamy Kurinchi, Tran Maxine G B
Specialist Centre for Kidney Cancer Royal Free London NHS Foundation Trust London UK.
Division of Surgery and Interventional Science University College London London UK.
BJUI Compass. 2025 Apr 22;6(4):e70018. doi: 10.1002/bco2.70018. eCollection 2025 Apr.
To understand the variable utilisation of diagnostic biopsy for small renal masses (SRM) across the urology community, we worked with expert clinicians and patients to produce a consensus statement on the role of biopsy and to identify research gaps.
In phase I, qualitative interviews were performed to identify potential statements on the role of biopsy and research gaps. In phase II, an expert panel including patients scored statements on a 9-point scale through a modified Delphi process involving three rounds of web-based surveys. Consensus was considered to have been reached when 70% of participants scored a statement greater than or equal to seven. Panel members could propose additional statements for consideration after the first round. Following the second round, a moderation meeting was held to discuss statements where threshold of agreement was not met.
In total, 35 participants were involved in this project and consisted of 23 clinicians and 12 patients, with 29 participants completing all three rounds. Overall, 18 statements reached consensus, 11 of which pertained to when and how a biopsy should be used in SRM management and 7 research recommendations to improve the evidence base for biopsy use.
This Delphi consensus statement, co-produced by patients and clinicians, provides best-practice guidance on the current role of renal tumour biopsy, including offering biopsy prior to active treatment if the outcome would affect management and offering a second attempt should the first biopsy be non-diagnostic. Priority areas for future research included studies to evaluate how a biopsy affects choice of treatment and patient anxiety.
为了解整个泌尿外科领域对小肾肿块（SRM）诊断性活检的使用差异，我们与专家临床医生和患者合作，就活检的作用达成共识声明，并确定研究差距。
在第一阶段，进行定性访谈以确定关于活检作用和研究差距的潜在声明。在第二阶段，一个包括患者的专家小组通过三轮基于网络的调查的改良德尔菲法，以9分制对声明进行评分。当70%的参与者对一项声明的评分大于或等于7分时，认为达成了共识。第一轮后，小组成员可以提出其他声明以供考虑。第二轮后，召开了一次协调会议，讨论未达到一致阈值的声明。
共有35名参与者参与了该项目，包括23名临床医生和12名患者，其中29名参与者完成了所有三轮调查。总体而言，18项声明达成了共识，其中11项涉及在SRM管理中何时以及如何使用活检，7项是关于改善活检使用证据基础的研究建议。
这份由患者和临床医生共同制定的德尔菲共识声明，为肾肿瘤活检的当前作用提供了最佳实践指导，包括如果结果会影响治疗方案，则在积极治疗前进行活检，如果首次活检未得出诊断结果，则进行第二次尝试。未来研究的重点领域包括评估活检如何影响治疗选择和患者焦虑的研究。
