Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis

Wilson, Mitchell P; Katlariwala, Prayash; Murad, M. Hassan; Abele, Jonathan; McInnes, Matthew D. F.; Low, Gavin

doi:10.1007/s00261-020-02469-8

Cited by 38 publications

(30 citation statements)

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“…A very recent meta-analysis showed sensitivity and specificity of 88% and 95% for detecting benign versus malignant renal lesions when HOCTs were characterized as benign. 21 In our study, there were 2 chromophobe RCCs; 1 showed lowgrade uptake (less than ipsilateral parenchyma), and the other showed no uptake (negative). As mentioned earlier, chromophobe RCCs do contain mitochondria similar to oncocytomas but typically the mitochondria are abnormal.…”

confidence: 43%

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

Sistani

Bjazevic

Kassam

et al. 2020

CUAJ

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Introduction: Differentiation of renal cell carcinoma (RCC) from oncocytoma is a common diagnostic dilemma. A few studies have shown that 99mTc-sestamibi (MIBI) imaging has the potential to characterize indeterminate renal masses. This comparative study evaluated the utility of MIBI single-photon emission computed tomography-computed tomography (SPECT-CT) in the assessment and risk stratification of renal masses. Methods: A total of 29 patients with 31 renal masses who had cross-sectional imaging and MIBI SPECT-CT, were included. Lesions were categorized as either MIBI-positive or -negative on SPECT-CT. Individual lesion density ranged from 22–56 Hounsfield Units (HU) on the non-contrast CT part of SPECT-CT. Quantitative relative MIBI uptake was calculated by measuring tumor to ipsilateral renal parenchymal uptake. The imaging results were correlated with histopathology. Results: All oncocytic lesions, including seven oncocytomas and one hybrid oncocytic chromophobe tumor (100%), were positive on MIBI. One chromophobe RCC showed low-grade MIBI uptake. The remaining RCC subtypes, including 15 clear-cell, four papillary, two mixed clear-cell and papillary, and one chromophobe were MIBI-negative. The quantitative relative tumor uptake showed statistically significant higher uptake in the low-risk/oncocytic lesions compared to RCCs. Conclusions: This study demonstrates that MIBI SPECT-CT is valuable in the characterization of indeterminate renal masses. The combination of MIBI uptake on SPECT and lesion density on non-contrast CT can be used for risk stratification of renal masses. This technique may reduce the need for further imaging (multiphasic CT or magnetic resonance imaging), renal mass biopsy, or surgical resection of low-risk renal masses. Subsequently, more patients could be followed with active surveillance.

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confidence: 43%

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

Sistani

Bjazevic

Kassam

et al. 2020

CUAJ

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“…The main limitation of 99m Tc-sestamibi SPECT-CT is that it is potentially less able to differentiate oncocytoma from hybrid oncocytic-chromophobe tumours (HOCTs) and chromophobe RCC. In the previously mentioned systematic review, the specificity of 99m Tc-sestamibi SPECT-CT for detecting tumours on the oncocytoma-chromophobe RCC spectrum was 96% (95% CI 84-99%) [9]. A 99m Tc-sestamibi SPECT-CT demonstrating avid uptake therefore indicates a renal mass that could be considered as at best oncocytoma, and at worst an indolent form of RCC, which may also benefit from active monitoring, especially when considering personalised management options in the context of tumour size, patient wishes, and specific comorbidities.…”

Section: Discussionmentioning

confidence: 92%

“…A recent systematic review included four articles with a total of 117 lesions [9]. The pooled and weighted sensitivity and specificity values of 99m Tc-sestamibi SPECT-CT for distinguishing renal oncocytoma vs other renal lesions were 92% (95% CI 72-98%) and 88% (95% CI 79-94%), respectively, and 89% and 67%, respectively, for renal oncocytoma vs chromophobe RCC [9]. The high diagnostic accuracy of 99m Tcsestamibi SPECT-CT could see it adopted as an add-on or replacement test to RTB.…”

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confidence: 99%

‘Case of the Month’ from the Specialist Centre for Kidney Cancer, Royal Free London Hospital, UK: ^99mTc‐sestamibi SPECT‐CT to differentiate renal cell carcinoma from benign oncocytoma

Miller¹,

Campain

Boydell

et al. 2021

BJU International

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“…The meta-analysis was processed on the basis of study design, type of imaging modalities, type of radiotracers, type of RCC. To our knowledge, some of these dimensions have not been discussed in relevant meta-analyses [33][34][35]. This is one of the strengths of this study.…”

Section: Discussionmentioning

confidence: 95%

Diagnostic Performance of MRI, SPECT, and PET in Detecting Renal Cell Carcinoma: A Meta-Analysis

Yin

Zhong

et al. 2021

Preprint

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Background: Renal cell carcinoma (RCC) is one of the most common malignancies worldwide. Noninvasive imaging techniques, such as magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET), have been involved in increasing evolution to detect RCC. This meta-analysis aims to compare to compare the value of MRI, SPECT, and PET in the diagnosis of RCC, and to provide evidence for decision-making in terms of further research and clinical settings.Methods: Electronic databases including PubMed, Web of Science, Embase, and Cochrane Library were systemically searched. Studies concerning MRI, SPECT, and PET for the detection of RCC were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), with their respective 95% confidence interval (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated.Results: A total of 44 articles were finally detected for inclusion in this meta-analysis. The pooled sensitivities of MRI, SPECT, and PET were 0.80, 0.81, and 0.88, respectively. Their respective overall specificities were 0.90, 0.54, and 0.87. Results in the subgroup analysis of the performance of SPECT that the pooled sensitivity, specificity, and AUC of the prospective SPECT studies included were 0.80, 0.42, 0.80, respectively. In the analysis of 18F-FDG PET, the pooled sensitivity, specificity, and AUC were 0.88, 0.86, and 0.92, respectively. PET studies showed a pooled sensitivity, specificity, and AUC of 0.80, 0.85, and 0.85, respectively in the diagnosis of primary RCC. The pooled sensitivity, specificity, and AUC of PET studies in detecting recurrent or metastatic RCC were 0.93, 0.88, and 0.94.Conclusion: Our meta-analysis manifests that MRI and PET present better diagnostic value for the detection of RCC in comparison with SPECT. PET is superior in the diagnosis of recurrent or metastatic RCC.

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Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis

Cited by 38 publications

References 30 publications

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

‘Case of the Month’ from the Specialist Centre for Kidney Cancer, Royal Free London Hospital, UK: ^99mTc‐sestamibi SPECT‐CT to differentiate renal cell carcinoma from benign oncocytoma

Diagnostic Performance of MRI, SPECT, and PET in Detecting Renal Cell Carcinoma: A Meta-Analysis

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Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis

Cited by 38 publications

References 30 publications

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses

‘Case of the Month’ from the Specialist Centre for Kidney Cancer, Royal Free London Hospital, UK: 99mTc‐sestamibi SPECT‐CT to differentiate renal cell carcinoma from benign oncocytoma

Diagnostic Performance of MRI, SPECT, and PET in Detecting Renal Cell Carcinoma: A Meta-Analysis

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‘Case of the Month’ from the Specialist Centre for Kidney Cancer, Royal Free London Hospital, UK: ^99mTc‐sestamibi SPECT‐CT to differentiate renal cell carcinoma from benign oncocytoma