Impact of renal mass biopsy on decision-making experience for clinical T1 renal masses

No AccessJournal of UrologyOriginal Clinical Article28 Oct 2025Impact of renal mass biopsy on decision-making experience for clinical T1 renal masses Kathryn H. Gessner, MD, PhD Allison M. Deal, MS Amir Feinberg, MD Shannon Myers, BA Katherine Poulos, MS Hillary Heiling, PhD Sara Wobker, MD MPH Pranav Akella, Marc A. Bjurlin, DO, MSc Clayton Commander, MD, PhD Matthew I. Milowsky, MD Matthew E. Nielsen, MD MS Mathew Raynor, MD Angela B. Smith, MD, MS Eric Wallen, MD David C. Johnson, MD William Y. Kim, andMD Hung-Jui TanMD, MSHPM Kathryn H. GessnerKathryn H. Gessner Corresponding author: Kathryn H. Gessner, MD, PhD University of North Carolina, Chapel Hill Department of Urology 2116 Physician Office Building, Campus Box 7235 Chapel Hill, NC 27599-7235 Email: ([email protected]) Phone: 919-966-2571; Fax: 919-966-0098 https://orcid.org/0000-0002-0335-4467 , Allison M. DealAllison M. Deal Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC , Amir FeinbergAmir Feinberg Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Shannon MyersShannon Myers Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Katherine PoulosKatherine Poulos School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC , Hillary HeilingHillary Heiling Department of Biostatistics, Dana Farber Cancer Institute, Boston, MA , Sara WobkerSara Wobker Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Pranav AkellaPranav Akella Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Marc A. BjurlinMarc A. Bjurlin Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Clayton CommanderClayton Commander Department of Interventional Radiology, MBB Radiology, Jacksonville, FL , Matthew I. MilowskyMatthew I. Milowsky Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC , Matthew E. NielsenMatthew E. Nielsen Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC , Mathew RaynorMathew Raynor Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , Angela B. SmithAngela B. Smith Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Southeastern Section Representative, The Journal of Urology , Eric WallenEric Wallen Department of Urology, Medical University of South Carolina, Charleston, SC , David C. JohnsonDavid C. Johnson Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC , William Y. KimWilliam Y. Kim Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC , and Hung-Jui TanHung-Jui Tan Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC View All Author Informationhttps://doi.org/10.1097/JU.0000000000004832AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Due to uncertainty on best management, a subset of patients with small renal masses suspicious for kidney cancer experience elevated decisional conflict. We hypothesize that pathologic information from renal mass biopsy may improve patient decision-making. In this study, we evaluate the impact of renal mass biopsy on decisional conflict for patients with clinical T1 renal masses. Materials and Methods: A comparative, non-randomized clinical trial was performed at a large tertiary cancer center. Patients with new clinical T1 renal masses were self-assigned to standard-of-care biopsy. We used difference-in-difference analyses to assess change in decisional conflict scale by receipt of renal mass biopsy. Results: Among 250 participants, 25% underwent biopsy during initial decision-making period prior to definitive intervention. Biopsy was more common for patients with masses >4 cm vs. 0-2 cm (PR 2.41, 95% CI 1.20–4.82, p=0.01), high nephrometry score vs. low (PR 2.13, 95% CI 1.13–4.01, p=0.02), and higher maximizer-minimizer score (PR 1.02, 95% CI 1.00-1.05, p=0.04). On adjusted difference-in-difference analysis, there was a small, non-significant reduction in decisional conflict for subjects undergoing biopsy vs. no biopsy (-2.78, 95% CI -7.18-1.45, p=0.20). Among subgroups, difference-in-difference by biopsy was large for total decisional conflict score in patients who did not see an outside urologist (-6.22) and patients reporting lower communication scores (-8.24). Conclusions: Though renal mass biopsy did not significantly decrease decisional conflict in all patients, biopsy reduced decisional conflict in certain patient subsets, demonstrating the importance of further investigating how to better support patients after renal mass diagnosis. © 2025 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2025 by American Urological Association Education and Research, Inc.KeywordsRenal cell carcinomaShared decision-makingCore needle biopsy Author Information Kathryn H. Gessner Corresponding author: Kathryn H. Gessner, MD, PhD University of North Carolina, Chapel Hill Department of Urology 2116 Physician Office Building, Campus Box 7235 Chapel Hill, NC 27599-7235 Email: ([email protected]) Phone: 919-966-2571; Fax: 919-966-0098 More articles by this author Allison M. Deal Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Amir Feinberg Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Shannon Myers Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Katherine Poulos School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Hillary Heiling Department of Biostatistics, Dana Farber Cancer Institute, Boston, MA More articles by this author Sara Wobker Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Pranav Akella Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Marc A. Bjurlin Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Clayton Commander Department of Interventional Radiology, MBB Radiology, Jacksonville, FL More articles by this author Matthew I. Milowsky Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Matthew E. Nielsen Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Mathew Raynor Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Angela B. Smith Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Southeastern Section Representative, The Journal of Urology More articles by this author Eric Wallen Department of Urology, Medical University of South Carolina, Charleston, SC More articles by this author David C. Johnson Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author William Y. Kim Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Hung-Jui Tan Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC More articles by this author Expand All Advertisement PDF downloadLoading ...