Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY Collaborative.
Identifieur interne : 000322 ( Main/Exploration ); précédent : 000321; suivant : 000323Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY Collaborative.
Auteurs : Henry Peabody [États-Unis] ; Amit Patel [États-Unis] ; Anna Johnson [États-Unis] ; Mahin Mirza [États-Unis] ; Sabrina L. Noyes [États-Unis] ; Edward Schervish [États-Unis] ; Sanjeev Kaul [États-Unis] ; Craig G. Rogers [États-Unis] ; Brian R. Lane [États-Unis] ; Alice Semerjian [États-Unis]Source :
- The Journal of urology [ 1527-3792 ] ; 2020.
Descripteurs français
- KwdFr :
- Amélioration de la qualité (MeSH), Biopsie (normes), Guides de bonnes pratiques cliniques comme sujet (MeSH), Humains (MeSH), Néphrectomie (normes), Néphrectomie (statistiques et données numériques), Observation (surveillance clinique) (normes), Prise de décision clinique (méthodes), Rein (anatomopathologie), Rein (chirurgie), Rein (imagerie diagnostique), Résultat thérapeutique (MeSH), Stadification tumorale (MeSH), Sujet âgé (MeSH), Surmédicalisation (prévention et contrôle), Tumeurs du rein (anatomopathologie), Tumeurs du rein (chirurgie), Tumeurs du rein (diagnostic), Études rétrospectives (MeSH).
- MESH :
- anatomopathologie : Rein, Tumeurs du rein.
- chirurgie : Rein, Tumeurs du rein.
- diagnostic : Tumeurs du rein.
- imagerie diagnostique : Rein.
- méthodes : Prise de décision clinique.
- normes : Biopsie, Néphrectomie, Observation (surveillance clinique).
- prévention et contrôle : Surmédicalisation.
- statistiques et données numériques : Néphrectomie.
- Amélioration de la qualité, Guides de bonnes pratiques cliniques comme sujet, Humains, Résultat thérapeutique, Stadification tumorale, Sujet âgé, Études rétrospectives.
English descriptors
- KwdEn :
- Aged (MeSH), Biopsy (standards), Clinical Decision-Making (methods), Humans (MeSH), Kidney (diagnostic imaging), Kidney (pathology), Kidney (surgery), Kidney Neoplasms (diagnosis), Kidney Neoplasms (pathology), Kidney Neoplasms (surgery), Medical Overuse (prevention & control), Neoplasm Staging (MeSH), Nephrectomy (standards), Nephrectomy (statistics & numerical data), Practice Guidelines as Topic (MeSH), Quality Improvement (MeSH), Retrospective Studies (MeSH), Treatment Outcome (MeSH), Watchful Waiting (standards).
- MESH :
- diagnosis : Kidney Neoplasms.
- diagnostic imaging : Kidney.
- methods : Clinical Decision-Making.
- pathology : Kidney, Kidney Neoplasms.
- prevention & control : Medical Overuse.
- standards : Biopsy, Nephrectomy, Watchful Waiting.
- statistics & numerical data : Nephrectomy.
- surgery : Kidney, Kidney Neoplasms.
- Aged, Humans, Neoplasm Staging, Practice Guidelines as Topic, Quality Improvement, Retrospective Studies, Treatment Outcome.
Abstract
PURPOSE
Nonmalignant pathology has been reported in 15% to 20% of surgeries for cT1 renal masses. We seek to identify opportunities for improvement in avoiding surgery for nonmalignant pathology.
MATERIALS AND METHODS
MUSIC-KIDNEY started collecting data in 2017. All patients with cT1 renal masses who had partial or radical nephrectomy for nonmalignant pathology were identified. Category for improvement (none-0, minor-1, moderate-2 or major-3) was independently assigned to each case by 5 experienced kidney surgeons. Specific strategies to decrease nonmalignant pathology were identified.
RESULTS
Of 1,392 patients with cT1 renal masses 653 underwent surgery and 74 had nonmalignant pathology (11%). Of these, 23 (31%) cases were cT1b. Radical nephrectomy was performed in 17 (22.9%) patients for 5 cT1a and 12 cT1b lesions. Only 6 patients had a biopsy prior to surgery (5 oncocytoma, 1 unclassified renal cell carcinoma). Review identified 25 cases with minor (34%), 26 with moderate (35%) and 10 with major (14%) quality improvement opportunities. Overall 17% of cases had no quality improvement opportunities identified (12 partial nephrectomy, 1 radical nephrectomy).
CONCLUSIONS
Review of patients with cT1 renal masses who underwent surgery for nonmalignant pathology revealed a significant number of cases in which this outcome may have been avoided. Approximately half of cases had moderate or major quality improvement opportunities, with radical nephrectomy for nonmalignant pathology being the most common reason. Our data indicate a lowest achievable and acceptable rate of nonmalignant pathology to be 1.9% and 5.4%, respectively. Avoiding interventions for nonmalignant pathology, particularly radical nephrectomy, is an important focus of quality improvement efforts. Strategies to decrease unnecessary interventions for nonmalignant pathology include greater use of repeat imaging, renal mass biopsy and surveillance.
DOI: 10.1097/JU.0000000000001238
PubMed: 32628102
Affiliations:
Links toward previous steps (curation, corpus...)
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Noyes</name><affiliation wicri:level="2"><nlm:affiliation>Spectrum Health Hospital System, Grand Rapids, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Spectrum Health Hospital System, Grand Rapids</wicri:cityArea></affiliation></author><author><name sortKey="Schervish, Edward" sort="Schervish, Edward" uniqKey="Schervish E" first="Edward" last="Schervish">Edward Schervish</name><affiliation wicri:level="2"><nlm:affiliation>Michigan Institute of Urology, St. Clair Shores, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Michigan Institute of Urology, St. Clair Shores</wicri:cityArea></affiliation></author><author><name sortKey="Kaul, Sanjeev" sort="Kaul, Sanjeev" uniqKey="Kaul S" first="Sanjeev" last="Kaul">Sanjeev Kaul</name><affiliation wicri:level="2"><nlm:affiliation>Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Comprehensive Urology, William Beaumont Hospital, Royal Oak</wicri:cityArea></affiliation></author><author><name sortKey="Rogers, Craig G" sort="Rogers, Craig G" uniqKey="Rogers C" first="Craig G" last="Rogers">Craig G. Rogers</name><affiliation wicri:level="2"><nlm:affiliation>Henry Ford Health System, Detroit, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Henry Ford Health System, Detroit</wicri:cityArea></affiliation></author><author><name sortKey="Lane, Brian R" sort="Lane, Brian R" uniqKey="Lane B" first="Brian R" last="Lane">Brian R. Lane</name><affiliation wicri:level="2"><nlm:affiliation>Spectrum Health Hospital System, Grand Rapids, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Spectrum Health Hospital System, Grand Rapids</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Michigan State University College of Human Medicine, Grand Rapids, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>Michigan State University College of Human Medicine, Grand Rapids</wicri:cityArea></affiliation></author><author><name sortKey="Semerjian, Alice" sort="Semerjian, Alice" uniqKey="Semerjian A" first="Alice" last="Semerjian">Alice Semerjian</name><affiliation wicri:level="2"><nlm:affiliation>IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Michigan</region></placeName><wicri:cityArea>IHA Urology, St. Joseph Mercy Hospital, Ann Arbor</wicri:cityArea></affiliation></author></analytic><series><title level="j">The Journal of urology</title><idno type="eISSN">1527-3792</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Biopsy (standards)</term><term>Clinical Decision-Making (methods)</term><term>Humans (MeSH)</term><term>Kidney (diagnostic imaging)</term><term>Kidney (pathology)</term><term>Kidney (surgery)</term><term>Kidney Neoplasms (diagnosis)</term><term>Kidney Neoplasms (pathology)</term><term>Kidney Neoplasms (surgery)</term><term>Medical Overuse (prevention & control)</term><term>Neoplasm Staging (MeSH)</term><term>Nephrectomy (standards)</term><term>Nephrectomy (statistics & numerical data)</term><term>Practice Guidelines as Topic (MeSH)</term><term>Quality Improvement (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Treatment Outcome (MeSH)</term><term>Watchful Waiting (standards)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Amélioration de la qualité (MeSH)</term><term>Biopsie (normes)</term><term>Guides de bonnes pratiques cliniques comme sujet (MeSH)</term><term>Humains (MeSH)</term><term>Néphrectomie (normes)</term><term>Néphrectomie (statistiques et données numériques)</term><term>Observation (surveillance clinique) (normes)</term><term>Prise de décision clinique (méthodes)</term><term>Rein (anatomopathologie)</term><term>Rein (chirurgie)</term><term>Rein (imagerie diagnostique)</term><term>Résultat thérapeutique (MeSH)</term><term>Stadification tumorale (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Surmédicalisation (prévention et contrôle)</term><term>Tumeurs du rein (anatomopathologie)</term><term>Tumeurs du rein (chirurgie)</term><term>Tumeurs du rein (diagnostic)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Rein</term><term>Tumeurs du rein</term></keywords><keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Rein</term><term>Tumeurs du rein</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Kidney Neoplasms</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Tumeurs du rein</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Kidney</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Rein</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Clinical Decision-Making</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Prise de décision clinique</term></keywords><keywords scheme="MESH" qualifier="normes" xml:lang="fr"><term>Biopsie</term><term>Néphrectomie</term><term>Observation (surveillance clinique)</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Kidney</term><term>Kidney Neoplasms</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Medical Overuse</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Surmédicalisation</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Biopsy</term><term>Nephrectomy</term><term>Watchful Waiting</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Nephrectomy</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Néphrectomie</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Kidney</term><term>Kidney Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Humans</term><term>Neoplasm Staging</term><term>Practice Guidelines as Topic</term><term>Quality Improvement</term><term>Retrospective Studies</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Amélioration de la qualité</term><term>Guides de bonnes pratiques cliniques comme sujet</term><term>Humains</term><term>Résultat thérapeutique</term><term>Stadification tumorale</term><term>Sujet âgé</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>PURPOSE</b></p><p>Nonmalignant pathology has been reported in 15% to 20% of surgeries for cT1 renal masses. We seek to identify opportunities for improvement in avoiding surgery for nonmalignant pathology.</p></div><div type="abstract" xml:lang="en"><p><b>MATERIALS AND METHODS</b></p><p>MUSIC-KIDNEY started collecting data in 2017. All patients with cT1 renal masses who had partial or radical nephrectomy for nonmalignant pathology were identified. Category for improvement (none-0, minor-1, moderate-2 or major-3) was independently assigned to each case by 5 experienced kidney surgeons. Specific strategies to decrease nonmalignant pathology were identified.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of 1,392 patients with cT1 renal masses 653 underwent surgery and 74 had nonmalignant pathology (11%). Of these, 23 (31%) cases were cT1b. Radical nephrectomy was performed in 17 (22.9%) patients for 5 cT1a and 12 cT1b lesions. Only 6 patients had a biopsy prior to surgery (5 oncocytoma, 1 unclassified renal cell carcinoma). Review identified 25 cases with minor (34%), 26 with moderate (35%) and 10 with major (14%) quality improvement opportunities. Overall 17% of cases had no quality improvement opportunities identified (12 partial nephrectomy, 1 radical nephrectomy).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Review of patients with cT1 renal masses who underwent surgery for nonmalignant pathology revealed a significant number of cases in which this outcome may have been avoided. Approximately half of cases had moderate or major quality improvement opportunities, with radical nephrectomy for nonmalignant pathology being the most common reason. Our data indicate a lowest achievable and acceptable rate of nonmalignant pathology to be 1.9% and 5.4%, respectively. Avoiding interventions for nonmalignant pathology, particularly radical nephrectomy, is an important focus of quality improvement efforts. Strategies to decrease unnecessary interventions for nonmalignant pathology include greater use of repeat imaging, renal mass biopsy and surveillance.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32628102</PMID><DateCompleted><Year>2020</Year><Month>11</Month><Day>24</Day></DateCompleted><DateRevised><Year>2020</Year><Month>11</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1527-3792</ISSN><JournalIssue CitedMedium="Internet"><Volume>204</Volume><Issue>6</Issue><PubDate><Year>2020</Year><Month>12</Month></PubDate></JournalIssue><Title>The Journal of urology</Title><ISOAbbreviation>J Urol</ISOAbbreviation></Journal><ArticleTitle>Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY Collaborative.</ArticleTitle><Pagination><MedlinePgn>1160-1165</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/JU.0000000000001238</ELocationID><Abstract><AbstractText Label="PURPOSE">Nonmalignant pathology has been reported in 15% to 20% of surgeries for cT1 renal masses. We seek to identify opportunities for improvement in avoiding surgery for nonmalignant pathology.</AbstractText><AbstractText Label="MATERIALS AND METHODS">MUSIC-KIDNEY started collecting data in 2017. All patients with cT1 renal masses who had partial or radical nephrectomy for nonmalignant pathology were identified. Category for improvement (none-0, minor-1, moderate-2 or major-3) was independently assigned to each case by 5 experienced kidney surgeons. Specific strategies to decrease nonmalignant pathology were identified.</AbstractText><AbstractText Label="RESULTS">Of 1,392 patients with cT1 renal masses 653 underwent surgery and 74 had nonmalignant pathology (11%). Of these, 23 (31%) cases were cT1b. Radical nephrectomy was performed in 17 (22.9%) patients for 5 cT1a and 12 cT1b lesions. Only 6 patients had a biopsy prior to surgery (5 oncocytoma, 1 unclassified renal cell carcinoma). Review identified 25 cases with minor (34%), 26 with moderate (35%) and 10 with major (14%) quality improvement opportunities. Overall 17% of cases had no quality improvement opportunities identified (12 partial nephrectomy, 1 radical nephrectomy).</AbstractText><AbstractText Label="CONCLUSIONS">Review of patients with cT1 renal masses who underwent surgery for nonmalignant pathology revealed a significant number of cases in which this outcome may have been avoided. Approximately half of cases had moderate or major quality improvement opportunities, with radical nephrectomy for nonmalignant pathology being the most common reason. Our data indicate a lowest achievable and acceptable rate of nonmalignant pathology to be 1.9% and 5.4%, respectively. Avoiding interventions for nonmalignant pathology, particularly radical nephrectomy, is an important focus of quality improvement efforts. Strategies to decrease unnecessary interventions for nonmalignant pathology include greater use of repeat imaging, renal mass biopsy and surveillance.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Peabody</LastName><ForeName>Henry</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Spectrum Health Hospital System, Grand Rapids, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Patel</LastName><ForeName>Amit</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Henry Ford Health System, Detroit, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Johnson</LastName><ForeName>Anna</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Michigan Medicine, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mirza</LastName><ForeName>Mahin</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Michigan Medicine, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Noyes</LastName><ForeName>Sabrina L</ForeName><Initials>SL</Initials><AffiliationInfo><Affiliation>Spectrum Health Hospital System, Grand Rapids, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schervish</LastName><ForeName>Edward</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Michigan Institute of Urology, St. Clair Shores, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kaul</LastName><ForeName>Sanjeev</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rogers</LastName><ForeName>Craig G</ForeName><Initials>CG</Initials><AffiliationInfo><Affiliation>Henry Ford Health System, Detroit, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lane</LastName><ForeName>Brian R</ForeName><Initials>BR</Initials><AffiliationInfo><Affiliation>Spectrum Health Hospital System, Grand Rapids, Michigan.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Michigan State University College of Human Medicine, Grand Rapids, Michigan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Semerjian</LastName><ForeName>Alice</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>07</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Urol</MedlineTA><NlmUniqueID>0376374</NlmUniqueID><ISSNLinking>0022-5347</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>J Urol. 2020 Dec;204(6):1165</RefSource><PMID Version="1">32970514</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001706" MajorTopicYN="N">Biopsy</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000066491" MajorTopicYN="N">Clinical Decision-Making</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007668" MajorTopicYN="N">Kidney</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007680" MajorTopicYN="N">Kidney Neoplasms</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000069342" MajorTopicYN="N">Medical Overuse</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009367" MajorTopicYN="N">Neoplasm Staging</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009392" MajorTopicYN="N">Nephrectomy</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017410" MajorTopicYN="N">Practice Guidelines as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058996" MajorTopicYN="Y">Quality Improvement</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D057832" MajorTopicYN="N">Watchful Waiting</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="N">standards</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">biopsy</Keyword><Keyword MajorTopicYN="Y">kidney</Keyword><Keyword MajorTopicYN="Y">nephrectomy</Keyword><Keyword MajorTopicYN="Y">quality improvement</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>7</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>11</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>7</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32628102</ArticleId><ArticleId IdType="doi">10.1097/JU.0000000000001238</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Michigan</li></region></list><tree><country name="États-Unis"><region name="Michigan"><name sortKey="Peabody, Henry" sort="Peabody, Henry" uniqKey="Peabody H" first="Henry" last="Peabody">Henry Peabody</name></region><name sortKey="Johnson, Anna" sort="Johnson, Anna" uniqKey="Johnson A" first="Anna" last="Johnson">Anna Johnson</name><name sortKey="Kaul, Sanjeev" sort="Kaul, Sanjeev" uniqKey="Kaul S" first="Sanjeev" last="Kaul">Sanjeev Kaul</name><name sortKey="Lane, Brian R" sort="Lane, Brian R" uniqKey="Lane B" first="Brian R" last="Lane">Brian R. Lane</name><name sortKey="Lane, Brian R" sort="Lane, Brian R" uniqKey="Lane B" first="Brian R" last="Lane">Brian R. Lane</name><name sortKey="Mirza, Mahin" sort="Mirza, Mahin" uniqKey="Mirza M" first="Mahin" last="Mirza">Mahin Mirza</name><name sortKey="Noyes, Sabrina L" sort="Noyes, Sabrina L" uniqKey="Noyes S" first="Sabrina L" last="Noyes">Sabrina L. Noyes</name><name sortKey="Patel, Amit" sort="Patel, Amit" uniqKey="Patel A" first="Amit" last="Patel">Amit Patel</name><name sortKey="Rogers, Craig G" sort="Rogers, Craig G" uniqKey="Rogers C" first="Craig G" last="Rogers">Craig G. Rogers</name><name sortKey="Schervish, Edward" sort="Schervish, Edward" uniqKey="Schervish E" first="Edward" last="Schervish">Edward Schervish</name><name sortKey="Semerjian, Alice" sort="Semerjian, Alice" uniqKey="Semerjian A" first="Alice" last="Semerjian">Alice Semerjian</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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