A Review of the Recommendations and Strength of Evidence for Clinical Practice Guidelines on the Management of Small Renal Masses
Document Type
Article
Publication Title
Journal of Endourology
Abstract
Introduction
With the rise in the detection of incidental small renal masses (SRM), the management paradigm for these patients has become an issue of increasing concern. We aim to identify areas of consensus, controversy, and opportunities for improvement among recently published guidelines and assess the strength of evidence for the management of SRMs.
Methods
We reviewed practice guidelines for SRMs promulgated by the American Urological Association, European Association of Urology, National Comprehensive Cancer Network, American Society of Clinical Oncology, European Society for Medical Oncology, and the Chinese Society of Clinical Oncology. Levels of evidence and strength of recommendations for evaluation, management and follow-up were analyzed with regard to consensus, conflict, and neglect.
Results
There is consensus among guidelines for the initial evaluation and treatment of SRMs, however, discrepancies exist with regard to indications for active surveillance, thermal ablation and timing/method of follow-up after treatment. Routine renal mass biopsy is not recommended by any guideline. Overwhelmingly, guideline statements are based on low to moderate levels of evidence; only 23% of the reviewed guidelines were based on high-level evidence; 38% based on moderate and 39% on low-level evidence or expert opinion.
Conclusions
Despite all six guidelines sharing a consensus on most management topics regarding SRMs, the ongoing lack of high-level evidence precludes gold standard recommendations in the areas of diagnosis, treatment, and follow-up. More high-quality studies are needed in order to develop stronger, data-supported universal guideline for the management of SRMs.
DOI
10.1089/end.2022.0840
Publication Date
5-31-2023
ISSN
1557-900X
Recommended Citation
Jiang P, Ali S, Peta A, Arada R, Brevik A, Xie L, Okhunov Z, Clayman R, Landman J. A Review of the Recommendations and Strength of Evidence for Clinical Practice Guidelines on the Management of Small Renal Masses. Journal of Endourology. 2023; . doi: 10.1089/end.2022.0840.
