Purpose of review: We evaluate the reasons that the majority of urologists infrequently biopsy a T1a small renal mass (SRM).
Recent findings: The majority of urologists report that a renal mass biopsy will not change their management in patients with a SRM given concerns of safety and efficacy of the biopsy. However, when comparing the safety and efficacy of SRM biopsy with neoplasms in all other major organ systems (all of which require biopsy prior to treatment), renal mass biopsy results are favorable. In addition to being safe and effective, renal mass biopsy should be more cost-effective for the healthcare system. Finally, in properly selected patients, renal mass biopsy can be performed in the urologist's office, thereby further decreasing cost.
Summary: Renal mass biopsy is an essential clinical tool that needs to be incorporated into the decision-making process among patients with a T1a SRM. A biopsy-driven, tissue-specific diagnosis of SRMes should become the standard of care in urology to bring us to parity with standard practice to management of lesions identified in every other organ system.