Our aim was to evaluate the feasibility and outcomes of a one-stop renal mass biopsy (RMB) clinic at which same-day biopsy results were facilitated by the use of confocal microscopy.
The Cambridge kidney One-Stop Mass Investigation Clinic (CkOSMIC) was established in January 2024. Patients underwent an ultrasound (US)-guided biopsy, and the sample was assessed via a confocal laser microscopy scan, which provided results within minutes. Traditional histopathology processing was also conducted. A historical cohort of patients who underwent RMB according to the standard pathology pathway was used as the comparator. We assessed the feasibility, safety, and diagnostic accuracy, as well as the acceptability among patients and clinicians.
Overall, CkOSMIC US-guided biopsy was conducted in 50 patients over a period of 12 mo, of whom 48 received a provisional diagnosis immediately. The sensitivity and specificity for identification of malignancy were 94% (29/31; 95% confidence interval [CI] 79–98%) and 100% (17/17; 95% CI 82–100%), respectively. There was complete agreement between confocal and final pathology for 91.7% (n = 44) of the patients, and partial concordance (cancer identified but equivocal histological subtype) for 8.3% (n = 4). Time from first consultation to a treatment decision, and time from biopsy to a treatment decision were significantly shorter in the CkOSMIC pathway (25 d, interquartile range [IQR] 15–42) than in the standard pathway (55 d, IQR 41–77; p < 0.001). Time from biopsy to a treatment decision was also significantly shorter in the CkOSMIC pathway (0 d) than in the standard pathway (24 d, IQR 17–34; p < 0.001). All participants were “satisfied” or “very satisfied” with the pathway.
CkOSMIC was feasible and showed high sensitivity and specificity in diagnosing cancer, while being safe and acceptable. It allows cancer targets to be met, reduces hospital visits and potentially reduces anxiety of delays in forming a treatment plan.
The use of renal mass biopsy (RMB) in determining the nature of small renal masses is still underused. Indeed, there are barriers to the implementation of RMB in the diagnostic pathway for renal tumours that pertain to both patients and clinicians. Besides uncertainties regarding diagnostic accuracy and risk of complications, potential delays in diagnosis and treatment are among the most frequently reported barriers.
To overcome these fears that may apply to virtually all cancer pathways, one-stop clinics have been investigated and developed. In these clinics, a patient has investigations and diagnosis within the same day. This service involves collaboration among multiple health care professionals, such as surgeons, pathologists, radiologists and specialised nurses. This initiative was originally developed for breast cancer and showed excellent sensitivity and specificity. In urology, one-stop haematuria clinics that combine flexible cystoscopy with imaging have been shown to reduce time from diagnosis to treatment, improve resource efficiency, and help reduce patient anxiety.
In this research by, Re et al., they performed a feasibility study of a one-stop clinic in the context of kidney cancer. Fifty patients with a radiologically confirmed renal mass deemed suitable for RMB after multidisciplinary discussion were referred to the one-stop RMB clinic over a period of 12 months (January 2024 – February 2025). Each patient underwent a US-guided biopsy under local anaesthesia, and the histological sample was assessed via ex vivo confocal microscopy, which provided results within minutes. Traditional histopathology processing was also conducted. Patients were then discharged after at least 4 hours, and treatment recommendation was discussed with the patient during their recovery. The aim of this study was to assess the feasibility, safety, and diagnostic accuracy, as well as the acceptability among patients and clinicians. Additionally, an historical cohort of patients (June 2018 – February 2020) who underwent RMB according to the standard pathology pathway was used as the comparator.
The sensitivity and specificity for identification of malignancy were 94% (29/31) and 100% (17/17), respectively. There was complete agreement between confocal and final pathology for 91.7% of the patients, while partial concordance (cancer identified but equivocal histological subtype) for 8.3%. Time from first consultation to a treatment decision, and time from biopsy to a treatment decision were significantly shorter in the CkOSMIC pathway (25 days, IQR15-42) than in the standard pathway (55 days IQR 41-77; p < 0.001). Time from biopsy to a treatment decision was also significantly shorter in the CkOSMIC pathway (0 days) than in the standard pathway (24 days, IQR 17-34; p < 0.001). All participants were “satisfied” or “very satisfied” with the pathway.
The results of the CkOSMIC study are noteworthy and demonstrated that the one-stop RMB pathway is feasible and achieves excellent outcomes. Indeed, the trial confirmed that RMB is a trustworthy procedure thanks to the excellent sensitivity and specificity, as well as the high concordance rate. Even more, this study demonstrated that the one-stop pathway can significantly reduce the interval between first consultation and treatment decision, allowing better efficiency and allocation of resources, as well as higher patients satisfaction. Finally, this study confirms that modern cancer management pathways need to incorporate a truly multidisciplinary approach.