Building Consensus, Improving Care: A New Approach to Kidney Tumour Biopsy
When someone is diagnosed with a small kidney tumour, having the right information at the right time can make a significant difference to the treatment they choose and receive. A significant challenge facing patients and clinicians is deciding whether the tumour requires treatment or active surveillance.
A kidney tumour biopsy, where a small sample of tissue is taken and examined, can help provide important information before treatment decisions are made. Prior to this project, there was no clear agreement on when patients diagnosed with a small renal mass (< 4cm on imaging scans) should be offered a kidney tumour biopsy. With support from The Urology Foundation, researchers brought together patients and leading kidney cancer specialists from across Europe to develop expert recommendations on the role of biopsy in managing small kidney tumours. The findings are already influencing clinical practice and have been incorporated into national guidance, helping to ensure patients receive the best care.
The challenge
Many small kidney tumours are found incidentally during scans performed for other reasons. While most are cancerous, a significant proportion are benign and may never require treatment.
Until this project, there was no clear consensus on when patients should be offered a kidney tumour biopsy. As a result, some patients may undergo surgery without having the fullest possible information about their tumour, while others may not have access to biopsy services at all.
Patients and clinicians both recognised the need for clear, evidence-based guidance to ensure biopsy is used appropriately and consistently. The Department of Health and Social Care recognised this challenge and have previously funded a study looking at the barriers and facilitators to offering a kidney tumour biopsy in the NHS (called the IFIT-B study).
Professor Maxine Tran, Professor in Urology said:
I am grateful for this generous funding from The Urology Foundation, which has not only translated to meaningful impact on the diagnostic pathway for patients with kidney tumours but has also been critical in enabling me to support a young urology trainee, Darryl Bernstein, on developing his academic career.
The research
Building from the results of the IFIT-B study, this project used a recognised consensus-building approach known as a Delphi process.
Professor Maxine Tran and her team of researchers at University College London brought together 38 clinicians, including urologists, radiologists and pathologists, alongside 14 patients with lived experience of kidney cancer. Through a series of structured surveys and discussions, the group was asked to identify areas of agreement about: (1) when a kidney tumour biopsy should be offered; and (2) what evidence is needed to encourage use of kidney tumour biopsy. 29 participants (76%) completed all three rounds of the process.
The study achieved consensus on 18 important recommendations. Key findings included agreement that:
- offering a kidney tumour biopsy before a patient pursues active treatment (surgery or heat/freezing therapy)
- offering a second attempt at biopsy following an initial non-diagnostic kidney tumour biopsy or if the first biopsy doesn’t provide a clear diagnosis.
- offering a kidney tumour biopsy to patients prior to starting on an active surveillance pathway
- providing access to a biopsy service to all individuals who wish to receive it
The study also identified priorities for future research, including studies to examine how biopsy affects patient treatment choice and anxiety.
View more information about this research HERE.
Our role
The Urology Foundation provided essential funding that enabled researchers to bring together experts and patients from across Europe to address an important clinical question that directly affects treatment decisions for people with kidney tumours.
By funding this work at a critical stage, we enabled research that has gone on to achieve international publication, win presentation awards at major scientific meetings and contribute to national clinical guidance.
Rebecca Porta, Chief Executive of The Urology Foundation said:
Thanks to the generosity of our supporters, research funded by The Urology Foundation is already improving care for people affected by kidney cancer. Together, we can continue to drive discoveries that lead to better diagnosis, better treatment decisions and better outcomes for patients.
Impact of the study
The impact of this project has already been significant. The project findings have been published, cited and included in the NICE guidelines for kidney cancer (NG256) meaning that patients across England and Wales should benefit from changes in clinical practice.
The recommendations provide practical guidance for clinicians across the NHS and beyond, helping to ensure patients receive more personalised care and better-informed treatment decisions.
Ultimately, this research has the potential to reduce unnecessary treatment, support shared decision-making and improve the experience of patients diagnosed with kidney tumours. It has also identified the most important unanswered questions, helping shape the next generation of kidney cancer research.
Next steps
The study identified several important priorities for future research. These recommendations are helping shape the next generation of research into improving care for people with small kidney tumours.
By supporting early-stage projects like this one, The Urology Foundation helps generate the evidence needed to transform patient care. Today’s donor-funded research becomes tomorrow’s clinical practice, benefiting patients across the UK and beyond.