Trends in Percutaneous Renal Mass Biopsy Utilization in the United States: A Contemporary Analysis of an All-Payer Discharge Database

Abstract

Purpose: Despite its theoretical benefit, it is unknown for which indications percutaneous renal mass biopsy (RMB) is actually used in clinical practice. This study aims to characterize trends in RMB utilization using data from a contemporary population-based cohort. Methods: Using ICD-9 codes, we captured data from the Premier Hospital Database of patients who underwent a RMB for a renal mass between 2004 and 2012. Based on an estimate of renal mass incidence, we determined utilization rate (annual RMB / annual patients with renal masses), 30-day RMB complication rate, and subsequent interventions within 90 days. Results: We identified 39,421 patients who underwent RMB; the annual number of RMB procedures in the U.S. ranged from 4000-5000. The RMB utilization rate for renal masses decreased from 9.5% in 2004 to 4.9% in 2012. Patients who underwent RMB tended to be older (71% >60 years old) and less healthy (43% Charlson Comorbidity Index ≥2); 20% had a concurrent metastatic disease and 17.2% had ablation as the subsequent intervention. Conclusions: Despite its safety and utility for guiding the management of renal masses, the utilization of percutaneous RMB is declining in the U.S.. Additional studies are needed to determine the barriers to adoption and to clarify the indications.