Histologic Patterns and Germline Genetic Testing Outcomes in Presumed Sporadic Bilateral Renal Masses

Among patients with BRMs with apparently sporadic etiology, strong concordance between bilateral histologies was observed. Although guidelines recommend genetic counseling for all patients with BRMs, our findings suggest that testing was underutilized and diagnostic yield was low, particularly for high-risk mutations (eg, von Hippel-Lindau or fumarate hydratase-deficient renal cell carcinoma). These findings suggest that genetic testing for patients with BRMs could be considered selectively, prioritizing patients with extrarenal manifestations, family history, young age, or pathology suspicious for hereditary etiology.