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

Abstract

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.

A review of 99mTc-sestamibi SPECT/CT for renal oncocytomas: A modified diagnostic algorithm

“…published in title or conference abstract format (10)(11)(12)(13). One additional study has been posted on the Cochrane Central Register of Controlled Trials but remains unpublished to date (14).…”

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

“…Renal biopsy is an accurate method to establish a histological diagnosis for RRC, however, it is may induce a risk of procedural adverse events [30]. Noninvasive approaches namely MRI, SPECT, and PET have been in evolution during the past decades [13,31,32]. Based on various studies of the diagnostic value of noninvasive modalities in the detection of RCC, we carry out a meta-analysis to compare the diagnostic e cacy of these approaches.…”

“…In recent years, targeted imaging approaches have made great progression in the diagnosis of RCC. Single photon emission computed tomography-computed tomography (SPECT) imaging is used to differentiate RCC and detect metastases in renal cancer [13,14]. Furthermore, positron emission tomography (PET) imaging utilizing 18 F-uoro-deoxy-glucose (FDG) and other tracers ( 124 I-girentuximab, 68 Ga-DOTATOC, 11 C-acetate, 18 F-Fluoride) has been studied as diagnostic biomarkers in RCC [15][16][17][18][19][20].…”

“…As far as we are concerned, a large number of studies have assessed the diagnostic performance of non-invasive approaches in terms of RCC, nevertheless, the results are heterogeneous [13,16,[20][21][22][23][24]. This study aimed to generate a more comprehensive comparison of the diagnostic performance of MRI, SPECT, and PET in the detection of RCC by conducting a meta-analysis, and subsequently to guide the diagnosis and differentiation of RCC in the eld of scienti c research and clinical application.…”

Canadian Urological Association guideline: Management of small renal masses – Full-text

“…Like mpMRI, 99mTc-sestamibi single-photon emission computed tomography (SPECT)/CT is being evaluated for detecting oncocytomas and other benign renal lesions. [112][113][114][115][116][117] Early results appear promising but require further validation before being routinely recommended in Canada.…”