The following is a summary of “Building a Roadmap for Surveillance of Renal Masses Using a Modified Delphi Method to Help Achieve Consensus,” published in the OCTOBER 2023 issue of Urology by Patel, et al.
For a study, researchers sought to establish a consensus for the initial evaluation and follow-up of patients undergoing active surveillance (AS) for T1 renal masses (T1RM).
Utilizing a modified Delphi method, the study gathered information on AS of T1RM, focusing on patient selection, timing and type of imaging modalities, and triggers for intervention. The consensus panel consisted of urologists affiliated with the Michigan Urological Surgery Improvement Collaborative, which is known for managing renal masses. Consensus areas were defined as achieving >80% agreement and determined iteratively through three online questionnaires.
The consensus panel comprised 26 urologists from the Michigan Urological Surgery Improvement Collaborative. Consensus was achieved for 321 out of 587 scenarios (54.7%) administered through 124 questions. Key factors influencing patient selection included life expectancy, age, comorbidity, and renal function, with life expectancy ranking as the most important. Tumors <3 cm and patients with a life expectancy <1 year were considered appropriate for AS. Other factors increasing appropriateness included elevated perioperative risk, increasing tumor complexity, and declining renal function. Imaging recommendations included multiphasic axial imaging initially (contrast CT for GFR >60 or MRI for GFR >30), with the first repeat imaging at 3-6 months and subsequent timing determined by tumor size. Chest imaging was recommended for tumors >3 cm initially and >5 cm during follow-up. Renal biopsy was not deemed a requirement for entering AS but was considered helpful in certain scenarios. Rapid tumor growth achieved consensus as an appropriate trigger for intervention.
The consensus panel successfully defined a clinically helpful and specific roadmap for AS of T1RM, identifying areas of agreement and highlighting topics for further discussion where consensus was not achieved.
Source: goldjournal.net/article/S0090-4295(23)00524-1/fulltext