Sasha N Bhan MD,MBA, Presenter: Nothing to Disclose

Stephen E Pautler MD, Abstract Co-Author: Nothing to Disclose

Bobby Shayegan MD, Abstract Co-Author: Nothing to Disclose

Maurice David Voss MBBCh, Abstract Co-Author: Nothing to Disclose

Ron E Goeree MA, Abstract Co-Author: Nothing to Disclose

John J You MD,MSc, Abstract Co-Author: Nothing to Disclose

The optimal strategy for the management of patients with a unilateral, cortical, small (≤ 4 cm) renal mass who are not candidates for or choose not to undergo surgery is unclear.

A decision-analytic Markov model was developed from the perspective of a third party payer to compare the quality-adjusted life expectancy and lifetime costs for 67-year-old patients with a small renal mass undergoing: pre-management decision biopsy, immediate percutaneous radiofrequency ablation or percutaneous cryoablation (without pre-management biopsy), or active surveillance with serial imaging and subsequent ablation if needed.

The dominant strategy (most effective and least costly) was active surveillance with subsequent cryoablation if needed. On a quality-adjusted and discounted basis, immediate cryoablation had a similar life expectancy (3 days fewer) but cost CAD $2,999 more. This result was sensitive to the relative rate of progression to metastatic disease. Strategies that employed radiofrequency ablation had decreased quality-adjusted life expectancies (82 to 87 days fewer than active surveillance plus cryoablation) due to higher rates of progression to metastatic disease, and higher costs ($3,230 to $6,389 more) due to higher rates of recurrence requiring retreatment. Strategies that employed biopsy had decreased quality-adjusted life expectancies (7 to 87 days fewer than active surveillance plus cryoablation) and higher costs ($3,484 to $6,398 more).

Active surveillance with delayed percutaneous cryoablation if needed may be a safe and cost-effective alternative to immediate cryoablation. The uncertainty in the relative long term rate of progression to metastatic disease in patients managed with active surveillance versus immediate cryoablation needs to be weighed against the higher cost of immediate cryoablation. A randomized trial is needed directly to evaluate strategies for the non-surgical management of patients with a small renal mass, and could be restricted to the most promising strategies identified in this analysis.

With more widespread adoption of active imaging surveillance and percutaneous cryoablation, radiologists may play an increasingly prominent role in the non-surgical management of patients with a SRM.

Bhan, S, Pautler, S, Shayegan, B, Voss, M, Goeree, R, You, J, Active Surveillance, Radiofrequency Ablation, or Cryoablation for the Non-surgical Management of Small Renal Masses: A Cost-Utility Analysis.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010650.html