Solved on SIR Connect

Original post

I have both biopsied and ablated suspicious renal masses in the same setting for years. I moved jobs within the last year and new relationships are forming between me and my new partners so we see each other’s usual practices. Recently some of my colleagues debated the finer points of biopsy and ablation in one vs. two settings, with two settings separated by 1–2 weeks.

Review of the literature is instructive but I will leave it there and look for the forum’s opinions. Thoughts?

—Paul J. Dorio, MD

Background

I completed my fellowship at Shock Trauma in Baltimore, Maryland, in 2002. Since that time, I have worked in private practice and have endeavored to expand awareness of interventional radiology among referring physicians and their support staff. Over time, as our colleagues’ awareness grew, so did our patient volume. Over the past 15 years, discussions with my urological surgery colleagues have helped to guide how we manage renal masses. Our renal mass intervention practice grew commensurate with our experience.

At our institution, the basic work-up of a patient with a renal mass is as follows:

1. Imaging shows a suspicious mass (i.e., grade 3 or 4 by Bosniak criteria), which prompts a discussion about treatment options.
2. Urological surgeons typically consult IR to initiate a discussion of treatment options, usually biopsy and ablation vs. surgery. This initial collaborative discussion between IR and urology occurs prior to face-to-face consultation between IR and the patient.
3. If anatomy is favorable, the patient is referred to IR for consultation and subsequent biopsy and ablation.

Why SIR Connect?

As physicians, we are charged with the care of people in need of our help. To ensure the highest quality care, it is critical to always keep abreast of new ideas and concepts. Furthermore, there are always slight differences in how interventionalists decide on a course of action. Those differences are what make IR exciting.

To explore how others view renal mass diagnosis and treatment, I submitted a query to the Open Forum on SIR Connect. In seeking the opinions and input of others, and adjusting my practice where appropriate, I hope that I’ve become a better doctor as a result.

What changed (if anything)?

Historically, my practice has been to biopsy and ablate in the same setting, when imaging is suspicious and definitive treatment is desired regardless of biopsy outcome. The Open Forum comments confirmed that there is no single best answer.

For appropriate patients, my existing practice to biopsy and ablate in the same setting remains a viable option. For cases where the imaging is less obvious but still warrants intervention, an initial biopsy may be the reasonable choice.

Do you use SIR Connect more now?

Since renewing my SIR membership, I’ve received the Open Forum emails on a daily basis. As a result, I have been active on the Forums when I see a topic that interests me. Overall, SIR Connect is a very effective use of social media and I applaud SIR for its development.