Prospective Evaluation of 99mTc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

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Abstract

Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12%) tumors were classified as renal oncocytomas and 2 (4%) as HOCTs. With the exception of 1 (2%) angiomyolipoma, all other tumors were renal cell carcinomas (82%). 99mTc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3%) oncocytomas and 2 of 2 (100%) HOCTs, resulting in an overall sensitivity of 87.5% (95% confidence interval [CI], 47.4-99.7%). Only two tumors were falsely positive on SPECT/CT, resulting in a specificity of 95.2% (95% CI, 83.8-99.4%). In summary, 99mTc-sestamibi SPECT/CT is a promising imaging test for the noninvasive diagnosis of renal oncocytomas and HOCTs. Patient summary: We found that the imaging test 99mTc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor. Imaging with 99mTc-sestamibi SPECT/CT allowed for the sensitive and specific differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors from other renal tumor histologies. Pending confirmatory study, this test may be eventually used for the pretreatment risk stratification of patients presenting with an indeterminate renal mass.

Original languageEnglish (US)
JournalEuropean Urology
DOIs
StateAccepted/In press - 2015

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Technetium Tc 99m Sestamibi
Single-Photon Emission-Computed Tomography
Tomography
X-Rays
Neoplasms
Kidney
Oxyphilic Adenoma
Histology
Renal oncocytoma
Confidence Intervals
Angiomyolipoma
Surgical Pathology
Renal Cell Carcinoma

Keywords

  • <sup>99m</sup>Tc-sestamibi
  • Oncocytoma
  • Renal cell carcinoma
  • Risk stratification
  • Small renal mass

ASJC Scopus subject areas

  • Urology

Cite this

@article{384f6529c3fa4fec9f395e6d9ff3521e,
title = "Prospective Evaluation of 99mTc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors",
abstract = "Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12{\%}) tumors were classified as renal oncocytomas and 2 (4{\%}) as HOCTs. With the exception of 1 (2{\%}) angiomyolipoma, all other tumors were renal cell carcinomas (82{\%}). 99mTc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3{\%}) oncocytomas and 2 of 2 (100{\%}) HOCTs, resulting in an overall sensitivity of 87.5{\%} (95{\%} confidence interval [CI], 47.4-99.7{\%}). Only two tumors were falsely positive on SPECT/CT, resulting in a specificity of 95.2{\%} (95{\%} CI, 83.8-99.4{\%}). In summary, 99mTc-sestamibi SPECT/CT is a promising imaging test for the noninvasive diagnosis of renal oncocytomas and HOCTs. Patient summary: We found that the imaging test 99mTc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor. Imaging with 99mTc-sestamibi SPECT/CT allowed for the sensitive and specific differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors from other renal tumor histologies. Pending confirmatory study, this test may be eventually used for the pretreatment risk stratification of patients presenting with an indeterminate renal mass.",
keywords = "<sup>99m</sup>Tc-sestamibi, Oncocytoma, Renal cell carcinoma, Risk stratification, Small renal mass",
author = "Michael Gorin and Steven Rowe and Alexander Baras and Lilja Solnes and Ball, {Mark W.} and Pierorazio, {Phillip Martin} and Christian Pavlovich and Epstein, {Jonathan Ira} and Javadi, {Mehrbod Som Som} and Allaf, {Mohamad E}",
year = "2015",
doi = "10.1016/j.eururo.2015.08.056",
language = "English (US)",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",

}

TY - JOUR

T1 - Prospective Evaluation of 99mTc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

AU - Gorin, Michael

AU - Rowe, Steven

AU - Baras, Alexander

AU - Solnes, Lilja

AU - Ball, Mark W.

AU - Pierorazio, Phillip Martin

AU - Pavlovich, Christian

AU - Epstein, Jonathan Ira

AU - Javadi, Mehrbod Som Som

AU - Allaf, Mohamad E

PY - 2015

Y1 - 2015

N2 - Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12%) tumors were classified as renal oncocytomas and 2 (4%) as HOCTs. With the exception of 1 (2%) angiomyolipoma, all other tumors were renal cell carcinomas (82%). 99mTc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3%) oncocytomas and 2 of 2 (100%) HOCTs, resulting in an overall sensitivity of 87.5% (95% confidence interval [CI], 47.4-99.7%). Only two tumors were falsely positive on SPECT/CT, resulting in a specificity of 95.2% (95% CI, 83.8-99.4%). In summary, 99mTc-sestamibi SPECT/CT is a promising imaging test for the noninvasive diagnosis of renal oncocytomas and HOCTs. Patient summary: We found that the imaging test 99mTc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor. Imaging with 99mTc-sestamibi SPECT/CT allowed for the sensitive and specific differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors from other renal tumor histologies. Pending confirmatory study, this test may be eventually used for the pretreatment risk stratification of patients presenting with an indeterminate renal mass.

AB - Nuclear imaging offers a potential noninvasive means of determining the histology of renal tumors. The aim of this study was to evaluate the accuracy of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/x-ray computed tomography (SPECT/CT) for the differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. In total, 50 patients with a solid clinical T1 renal mass were imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection. Preoperative SPECT/CT scans were reviewed by two blinded readers, and their results were compared with centrally reviewed surgical pathology data. Following surgery, 6 (12%) tumors were classified as renal oncocytomas and 2 (4%) as HOCTs. With the exception of 1 (2%) angiomyolipoma, all other tumors were renal cell carcinomas (82%). 99mTc-sestamibi SPECT/CT correctly identified 5 of 6 (83.3%) oncocytomas and 2 of 2 (100%) HOCTs, resulting in an overall sensitivity of 87.5% (95% confidence interval [CI], 47.4-99.7%). Only two tumors were falsely positive on SPECT/CT, resulting in a specificity of 95.2% (95% CI, 83.8-99.4%). In summary, 99mTc-sestamibi SPECT/CT is a promising imaging test for the noninvasive diagnosis of renal oncocytomas and HOCTs. Patient summary: We found that the imaging test 99mTc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor. Imaging with 99mTc-sestamibi SPECT/CT allowed for the sensitive and specific differentiation of oncocytomas and hybrid oncocytic/chromophobe tumors from other renal tumor histologies. Pending confirmatory study, this test may be eventually used for the pretreatment risk stratification of patients presenting with an indeterminate renal mass.

KW - <sup>99m</sup>Tc-sestamibi

KW - Oncocytoma

KW - Renal cell carcinoma

KW - Risk stratification

KW - Small renal mass

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DO - 10.1016/j.eururo.2015.08.056

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JF - European Urology

SN - 0302-2838

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