title: Utilization of renal mass biopsy in patients with renal cell carcinoma.
abstract: OBJECTIVE
  To examine the patient, tumor, and temporal factors associated with receipt of renal mass biopsy (RMB) in a contemporary nationally representative sample.
  
  
  METHODS
  We queried the Surveillance, Epidemiology, and End Results-Medicare data set for incident cases of renal cell carcinoma diagnosed between 1992 and 2007. We tested for associations among receipt of RMB and patient and tumor characteristics, type of therapy, and procedure type. Temporal trends in receipt of RMB were characterized over the study period.
  
  
  RESULTS
  Approximately 1 in 5 (20.7%) patients diagnosed with renal cell carcinoma (n = 24,702) underwent RMB before instituting therapy. There was a steady and modest increase in RMB utilization, with the highest utilization (30%) occurring in the final study year. Of patients who underwent radical (n = 15,666) or partial (n = 2211) nephrectomy, 17% and 20%, respectively, underwent RMB in advance of surgery. Sixty-five percent of patients who underwent ablation (n = 314) underwent RMB before or in conjunction with the procedure. Roughly half of patients (50.4%) treated with systemic therapy alone underwent RMB. Factors independently associated with use of RMB included younger age, black race, Hispanic ethnicity, tumor size <7 cm, and metastatic disease at presentation.
  
  
  CONCLUSIONS
  At present, most patients who eventually undergo radical or partial nephrectomy do not undergo RMB, whereas most patients who eventually undergo ablation or systemic therapy do. The optimal use of RMB in the evaluation of kidney tumors has yet to be determined.
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA. Electronic address: jleppert@stanford.edu.
authors: John T
authors: JT
authors: Leppert
authors: Rand Corporation, Santa Monica, CA.
authors: Janet
authors: J
authors: Hanley
authors: Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
authors: Todd H
authors: TH
authors: Wagner
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors: Benjamin I
authors: BI
authors: Chung
authors: Department of Medicine, Stanford University School of Medicine, Stanford, CA.
authors: Sandy
authors: S
authors: Srinivas
authors: Department of Medicine, Stanford University School of Medicine, Stanford, CA.
authors: Glenn M
authors: GM
authors: Chertow
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA.
authors: James D
authors: JD
authors: Brooks
authors: Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles, CA; Department of Health Services, University of California, Los Angeles School of Medicine, Los Angeles, CA.
authors: Christopher S
authors: CS
authors: Saigal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D006278:Medicare; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States