Abstract:
Introduction & objectives: For localised tumours of the fifteen most lethal cancers globally, we aimed to compare both biopsy recommendations from leading guidelines and biopsy outcomes.
Materials and methods: The most lethal fifteen malignancies globally were determined from recent publications, with haematological conditions then excluded. The primary outcome was identification of organs in which routine biopsy of suspicious solid localised resectable tumours was recommended by leading guidelines, and guideline reasons against routine biopsy (if any). Secondary outcomes were, from recent large volume studies for each organ, proportion of patients who received pre-operative biopsy, and biopsy sensitivity, specificity and complication rate.
Results: Routine pre-operative biopsy was guideline-recommended for all patients with localised tumours of the large bowel, stomach, breast, oesophagus, prostate, cervix and bladder, for most tumours of the lung or liver, and not routinely recommended for those of the pancreas, brain, ovary or kidney (leukaemia and non-Hodgkin’s lymphoma were excluded). Where non-routine, leading reasons were diagnostic accuracy being adequately high for imaging or inadequately low for biopsy, and biopsy risk. Pre-operative biopsy rates were 100% for tumours of all organs except the lung, liver, pancreas, brain, ovary and kidney. Biopsy sensitivity was >80% and specificity >90% for tumours of all organs except the cervix or ovary. Biopsy complication rate was <10% for all organs except the lung, prostate and bladder.
Conclusions: Amongst the most lethal cancers, biopsy of localised tumours is recommended and routinely performed for most organs. Outliers include lung, liver, pancreatic, brain, ovarian and renal masses.
Audience Take Away Notes:
• Of the most lethal 15 malignancies globally, pre-operative biopsy of localised tumours is routinely recommended and performed for most organs. Outliers include lung, liver, pancreatic, brain, ovarian and renal masses
• Where biopsy is not-routinely recommended, guideline reasons appear evidence-based for most tumours, but less so for renal tumours
• These findings prompt clinicians to reflect on practice, especially whether greater use of renal mass biopsy may reduce nephrectomy for benign tumours
