1
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Wu H, Lu L, Dong A, Han Y. Juxtaglomerular Cell Tumor Mimicking Renal Cell Carcinoma on 99m Tc-MIBI SPECT/CT. Clin Nucl Med 2024; 49:677-679. [PMID: 38598494 DOI: 10.1097/rlu.0000000000005223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
ABSTRACT Juxtaglomerular cell tumor or reninoma is an extremely rare, typically benign, renin-secreting tumor of the kidney that causes secondary hypertension. We describe 99m Tc-MIBI SPECT/CT findings in a case of juxtaglomerular cell tumor. The renal tumor showed isodensity and photopenia on 99m Tc-MIBI SPECT/CT. This case indicates that juxtaglomerular cell tumor can appear cold on 99m Tc-MIBI SPECT/CT, mimicking renal cell carcinoma.
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Affiliation(s)
- Haibo Wu
- From the Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Lingdan Lu
- From the Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yan Han
- From the Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
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2
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Warren H, Fanshawe JB, Mok V, Iyer P, Chan VW, Hesketh R, Zimmermann E, Kasivisvanathan V, Emberton M, Tran MGB, Gurusamy K. Imaging modalities for characterising T1 renal tumours: A systematic review and meta-analysis of diagnostic accuracy. BJUI COMPASS 2024; 5:636-650. [PMID: 39022655 PMCID: PMC11249832 DOI: 10.1002/bco2.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives International guidelines recommend resection of suspected localised renal cell carcinoma (RCC), with surgical series showing benign pathology in 30%. Non-invasive diagnostic tests to differentiate benign from malignant tumours are an unmet need. Our objective was to determine diagnostic accuracy of imaging modalities for detecting cancer in T1 renal tumours. Methods A systematic review was performed for reports of diagnostic accuracy of any imaging test compared to a reference standard of histopathology for T1 renal masses, from inception until January 2023. Twenty-seven publications (including 2277 tumours in 2044 participants) were included in the systematic review, and nine in the meta-analysis. Results Forest plots of sensitivity and specificity were produced for CT (seven records, 1118 participants), contrast-enhanced ultrasound (seven records, 197 participants), [99mTc]Tc-sestamibi SPECT/CT (five records, 263 participants), MRI (three records, 220 participants), [18F]FDG PET (four records, 43 participants), [68Ga]Ga-PSMA-11 PET (one record, 27 participants) and [111In]In-girentuximab SPECT/CT (one record, eight participants). Meta-analysis returned summary estimates of sensitivity and specificity for [99mTc]Tc-sestamibi SPECT/CT of 88.6% (95% CI 82.7%-92.6%) and 77.0% (95% CI 63.0%-86.9%) and for [18F]FDG PET 53.5% (95% CI 1.6%-98.8%) and 62.5% (95% CI 14.0%-94.5%), respectively. A comparison hierarchical summary receiver operating characteristic (HSROC) model did not converge. Meta-analysis was not performed for other imaging due to different thresholds for test positivity. Conclusion The optimal imaging strategy for T1 renal masses is not clear. [99mTc]Tc-sestamibi SPECT/CT is an emerging tool, but further studies are required to inform its role in clinical practice. The field would benefit from standardisation of diagnostic thresholds for CT, MRI and contrast-enhanced ultrasound to facilitate future meta-analyses.
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Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Free Hospital Specialist Centre for Kidney CancerLondonUK
| | | | - Valerie Mok
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Priyanka Iyer
- Guy's, King's and St Thomas' School of Medical EducationKing's College LondonLondonUK
| | | | - Richard Hesketh
- Centre of Medical Imaging AUniversity College LondonLondonUK
| | | | | | - Mark Emberton
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Maxine G. B. Tran
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Royal Free Hospital Specialist Centre for Kidney CancerLondonUK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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3
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Warren H, Tran MGB. 99mTc-sestamibi SPECT/CT-the jury is still out! Transl Androl Urol 2024; 13:1053-1055. [PMID: 38983466 PMCID: PMC11228679 DOI: 10.21037/tau-23-623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/11/2024] [Indexed: 07/11/2024] Open
Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Urology Department, Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Maxine G. B. Tran
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Urology Department, Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
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4
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Zhao Q, Dong A, Zuo C, Yang B. 99mTc-MIBI SPECT/CT in a Case of Renal Oncocytosis. Clin Nucl Med 2023:00003072-990000000-00645. [PMID: 37486723 DOI: 10.1097/rlu.0000000000004775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
ABSTRACT Renal oncocytosis is a very rare oncologically indolent form of renal neoplasia characterized by diffuse involvement of renal parenchyma by numerous oncocytic nodules. We describe contrast-enhanced CT and 99mTc-MIBI SPECT/CT findings in a patient with renal oncocytosis presenting with metachronous bilateral renal tumors. Contrast-enhanced CT showed numerous tumors ranging from several millimeters up to 3.9 cm in the left kidney. The tumors showed hypervascularity in the corticomedullary phase and washout in the excretory phase mimicking renal cell carcinoma. The larger tumors showed higher 99mTc-MIBI uptake than the adjacent renal parenchyma, suggesting renal oncocytoma confirmed by biopsy.
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Affiliation(s)
- Qian Zhao
- From the Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | | | | | - Bo Yang
- Urology, Changhai Hospital, Naval Medical University, Shanghai, China
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5
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Radiogenomics in Renal Cancer Management-Current Evidence and Future Prospects. Int J Mol Sci 2023; 24:ijms24054615. [PMID: 36902045 PMCID: PMC10003020 DOI: 10.3390/ijms24054615] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Renal cancer management is challenging from diagnosis to treatment and follow-up. In cases of small renal masses and cystic lesions the differential diagnosis of benign or malignant tissues has potential pitfalls when imaging or even renal biopsy is applied. The recent artificial intelligence, imaging techniques, and genomics advancements have the ability to help clinicians set the stratification risk, treatment selection, follow-up strategy, and prognosis of the disease. The combination of radiomics features and genomics data has achieved good results but is currently limited by the retrospective design and the small number of patients included in clinical trials. The road ahead for radiogenomics is open to new, well-designed prospective studies, with large cohorts of patients required to validate previously obtained results and enter clinical practice.
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6
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Molecular Imaging Diagnosis of Renal Cancer Using 99mTc-Sestamibi SPECT/CT and Girentuximab PET-CT-Current Evidence and Future Development of Novel Techniques. Diagnostics (Basel) 2023; 13:diagnostics13040593. [PMID: 36832081 PMCID: PMC9954934 DOI: 10.3390/diagnostics13040593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
Novel molecular imaging opportunities to preoperatively diagnose renal cell carcinoma is under development and will add more value in limiting the postoperative renal function loss and morbidity. We aimed to comprehensively review the research on single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography computed tomography (PET-CT) molecular imaging and to enhance the urologists' and radiologists' knowledge of the current research pattern. We identified an increase in prospective and also retrospective studies that researched to distinguish between benign and malignant lesions and between different clear cell renal cell carcinoma subtypes, with small numbers of patients studied, nonetheless with excellent results on specificity, sensitivity and accuracy, especially for 99mTc-sestamibi SPECT/CT that delivers quick results compared to a long acquisition time for girentuximab PET-CT, which instead gives better image quality. Nuclear medicine has helped clinicians in evaluating primary and secondary lesions, and has lately returned with new and exciting insights with novel radiotracers to reinforce its diagnostic potential in renal carcinoma. To further limit the renal function loss and post-surgery morbidity, future research is mandatory to validate the results and to clinically implement the diagnostic techniques in the context of precision medicine.
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7
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Parihar AS, Mhlanga J, Ronstrom C, Schmidt LR, Figenshau RS, Dehdashti F, Wahl RL. Diagnostic Accuracy of 99mTc-Sestamibi SPECT/CT for Characterization of Solid Renal Masses. J Nucl Med 2023; 64:90-95. [PMID: 35772963 DOI: 10.2967/jnumed.122.264329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023] Open
Abstract
Our objective was to assess the diagnostic accuracy of 99mTc-sestamibi SPECT/CT for characterizing solid renal masses. Methods: Imaging and clinical records of patients who underwent 99mTc-sestamibi SPECT/CT for clinical work-up of their solid renal masses from September 2018 to October 2021 were retrospectively reviewed. Histopathology formed the reference standard, and the diagnoses were categorized as malignant/concerning (renal cell carcinomas [RCCs] other than chromophobe histology) and benign/nonconcerning (oncocytic tumors including chromophobe RCC, other benign diagnoses) to calculate the sensitivity and specificity of 99mTc-sestamibi SPECT/CT and contrast-enhanced CT (ceCT). The clinical reads of the SPECT/CT images were used for visual classification of the lesions. Additionally, the SPECT images were manually segmented to obtain the maximum and mean counts of the lesion and adjacent renal cortex and maximum and mean lesion Hounsfield units. Results: 99mTc-sestamibi SPECT/CT was performed on 42 patients with 62 renal masses. A histopathologic diagnosis was available for 27 patients (18 male, 9 female) with 36 solid renal masses. ceCT findings were available for 20 of these patients. The most commonly identified single histologic type was clear cell RCC (13/36; 36.1%). Oncocytic tumors were the most common group of nonconcerning lesions (15/36), with oncocytoma as the predominant histologic type (n = 6). The sensitivity and specificity of SPECT/CT for diagnosing a nonconcerning lesion were 66.7% and 89.5%, respectively, compared with 10% and 75%, respectively, for ceCT. The lesion-to-kidney ratios for maximum and mean counts and maximum lesion Hounsfield units showed significant differences between the 2 groups (P < 0.05). The lesion-to-kidney mean count ratio at a cutoff of 0.46 showed a sensitivity and specificity of 87.5% and 86.67%, respectively, for detecting nonconcerning lesions, which was significantly higher than that of ceCT. Conclusion: The current literature on the utility of 99mTc-sestamibi SPECT/CT for characterization of solid renal masses is limited. We offer additional evidence of the incremental value of 99mTc-sestamibi SPECT/CT over ceCT for differentiating malignant or aggressive renal tumors from benign or indolent ones, thereby potentially avoiding overtreatment and its associated complications. Quantitative assessment can further increase the diagnostic accuracy of SPECT/CT and may be used in conjunction with visual interpretation.
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Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joyce Mhlanga
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
| | - Carrie Ronstrom
- Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and.,Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lisa R Schmidt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S Figenshau
- Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and.,Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; .,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
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8
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Tzortzakakis A, Papathomas T, Gustafsson O, Gabrielson S, Trpkov K, Ekström-Ehn L, Arvanitis A, Holstensson M, Karlsson M, Kokaraki G, Axelsson R. 99mTc-Sestamibi SPECT/CT and histopathological features of oncocytic renal neoplasia. Scand J Urol 2022; 56:375-382. [PMID: 36065481 DOI: 10.1080/21681805.2022.2119273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND 99mTc-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) contributes to the non-invasive differentiation of renal oncocytoma (RO) from renal cell carcinoma (RCC) by characterising renal tumours as Sestamibi positive or Sestamibi negative regarding their 99mTc-Sestamibi uptake compared to the non-tumoral renal parenchyma. PURPOSE To determine whether 99mTc- Sestamibi uptake in renal tumour and the non-tumoral renal parenchyma measured using Standard Uptake Value (SUV) SPECT, has a beneficial role in differentiating RO from RCC. MATERIAL AND METHODS Fifty-seven renal tumours from 52 patients were evaluated. In addition to visual evaluation of 99mTc-Sestamibi uptake, SUVmax measurements were performed in the renal tumour and the ipsilateral non-tumoral renal parenchyma. Analysis of the area under the receiver operating characteristic curve identified an optimal cut-off value for detecting RO, based on the relative ratio of 99mTc- Sestamibi uptake. RESULTS Semiquantitative evaluation of 99mTc-Sestamibi uptake did not improve the performance of 99mTc- Sestamibi SPECT/CT in detecting RO. 99mTc- Sestamibi SPECT/CT identifies a group of mostly indolent Sestamibi-positive tumours with low malignant potential containing RO, Low-Grade Oncocytic Tumours, Hybrid Oncocytic Tumours, and a subset of chromophobe RCCs. CONCLUSION The imaging limitations for accurate differentiation of Sestamibi-positive renal tumours mirror the recognised diagnostic complexities of the histopathologic evaluation of oncocytic neoplasia. Patients with Sestamibi-positive renal tumours could be better suited for biopsy and follow-up, according to the current active surveillance protocols.
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Affiliation(s)
- Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Thomas Papathomas
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Ove Gustafsson
- Division of Urology, Karolinska University Hospital, Huddinge, Sweden
| | - Stefan Gabrielson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Alberta Precision Labs, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Alexandros Arvanitis
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Maria Holstensson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden.,Division of Function and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet
| | - Mattias Karlsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Georgia Kokaraki
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Department of Clinical Pathology and Cytology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Rimma Axelsson
- Division of Radiology, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
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9
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Elsayed Sharaf D, Shebel H, El-Diasty T, Osman Y, Khater S, Abdelhamid M, Abou El Atta H. Nomogram predictive model for differentiation between renal oncocytoma and chromophobe renal cell carcinoma at multi-phasic CT: a retrospective study. Clin Radiol 2022; 77:767-775. [DOI: 10.1016/j.crad.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
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10
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Wilson MP, Katlariwala P, Abele J, Low G. A review of 99mTc-sestamibi SPECT/CT for renal oncocytomas: A modified diagnostic algorithm. Intractable Rare Dis Res 2022; 11:46-51. [PMID: 35702579 PMCID: PMC9161129 DOI: 10.5582/irdr.2022.01027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022] Open
Abstract
99mTc-sestamibi SPECT/CT is a promising nuclear medicine imaging investigation for benign renal lesions such as renal oncocytomas. The purpose of this article is to i) review the current literature on 99mTc-sestamibi SPECT/CT, ii) to review to current application of 99mTc-sestamibi SPECT/CT for indeterminate renal lesion imaging, and iii) to discuss present limitations and areas for future research. The literature has been reviewed up to April 2022 for articles relating to the application of 99mTc-sestamibi SPECT/CT for benign renal lesions including a recently published systematic review and meta-analysis performed by the authors. One study evaluating 99mTc-sestamibi SPECT alone and five studies evaluating 99mTc-sestamibi SPECT/CT have been performed to date. 99mTc-sestamibi SPECT/CT demonstrates high sensitivity and specificity for detecting benign renal lesions, particularly renal oncocytomas. 99mTc-sestamibi SPECT/CT demonstrates near-perfect specificity for benign and low-grade renal lesions. The optimal quantified threshold ratio for tumor-to-background renal parenchyma radiotracer uptake for a positive result is > 0.6. In this article, we propose a modified diagnostic algorithm for small enhancing renal masses measuring 1-4 cm in which suspected benign lesions after conventional imaging are considered for 99mTc-sestamibi SPECT-CT. In this algorithm, positive studies can be monitored with active surveillance rather than requiring invasive biopsy and/or targeted therapy.
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Affiliation(s)
- Mitchell P Wilson
- Address correspondence to:Mitchell P Wilson, Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, Alberta, Canada.
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11
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Roussel E, Capitanio U, Kutikov A, Oosterwijk E, Pedrosa I, Rowe SP, Gorin MA. Novel Imaging Methods for Renal Mass Characterization: A Collaborative Review. Eur Urol 2022; 81:476-488. [PMID: 35216855 PMCID: PMC9844544 DOI: 10.1016/j.eururo.2022.01.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 01/19/2023]
Abstract
CONTEXT The incidental detection of localized renal masses has been rising steadily, but a significant proportion of these tumors are benign or indolent and, in most cases, do not require treatment. At the present time, a majority of patients with an incidentally detected renal tumor undergo treatment for the presumption of cancer, leading to a significant number of unnecessary surgical interventions that can result in complications including loss of renal function. Thus, there exists a clinical need for improved tools to aid in the pretreatment characterization of renal tumors to inform patient management. OBJECTIVE To systematically review the evidence on noninvasive, imaging-based tools for solid renal mass characterization. EVIDENCE ACQUISITION The MEDLINE database was systematically searched for relevant studies on novel imaging techniques and interpretative tools for the characterization of solid renal masses, published in the past 10 yr. EVIDENCE SYNTHESIS Over the past decade, several novel imaging tools have offered promise for the improved characterization of indeterminate renal masses. Technologies of particular note include multiparametric magnetic resonance imaging of the kidney, molecular imaging with targeted radiopharmaceutical agents, and use of radiomics as well as artificial intelligence to enhance the interpretation of imaging studies. Among these, 99mTc-sestamibi single photon emission computed tomography/computed tomography (CT) for the identification of benign renal oncocytomas and hybrid oncocytic chromophobe tumors, and positron emission tomography/CT imaging with radiolabeled girentuximab for the identification of clear cell renal cell carcinoma, are likely to be closest to implementation in clinical practice. CONCLUSIONS A number of novel imaging tools stand poised to aid in the noninvasive characterization of indeterminate renal masses. In the future, these tools may aid in patient management by providing a comprehensive virtual biopsy, complete with information on tumor histology, underlying molecular abnormalities, and ultimately disease prognosis. PATIENT SUMMARY Not all renal tumors require treatment, as a significant proportion are either benign or have limited metastatic potential. Several innovative imaging tools have shown promise for their ability to improve the characterization of renal tumors and provide guidance in terms of patient management.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center. University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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12
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Viswambaram P, Picardo A, Hohnen A, Pham K, Macdonald W, Hayne D, Hamid A. 99m Tc sestamibi SPECT/CT in the prediction of malignant versus benign small renal masses. BJU Int 2022; 130 Suppl 3:23-31. [PMID: 35365966 DOI: 10.1111/bju.15737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the effectiveness of 99m Tc-sestamibi renal SPECT/CT in distinguishing between malignant and benign renal lesions. PATIENTS AND METHODS Between June 2018 and October 2020 all patients with new indeterminate small renal masses (SRMs) underwent 99m Tc-sestamibi renal SPECT/CT prior to biopsy or surgery. The accuracy of 99m Tc-sestamibi imaging diagnoses was assessed against histopathology. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off for the tumour:normal uptake ratio. Logistic regression was used to determine if quantitative analysis significantly added to visual interpretation alone. RESULTS A total of 74 patients with SRMs were investigated with 99m Tc-sestamibi SPECT/CT. SPECT/CT correctly identified 49 malignant tumours and 11 benign tumours, resulting in a sensitivity of 0.89 [95% CI: 0.77 - 0.95] and a specificity of 0.73 [95% CI: 0.45 - 0.91]. ROC analysis of uptake ratios demonstrated that a tumour:normal uptake ratio of 0.41 provided optimal diagnostic accuracy (sensitivity 0.81, specificity 0.88, area under the curve 0.883 [95% CI:0.794 - 0.971]). The uptake ratio was also highly significant in excluding malignancy on univariate logistic regression analysis whereby the higher the uptake ratio, the lower the chances were for malignancy (OR 0.009,95% CI: 0.001-0.118, p < 0.001. However, this did not improve diagnostic accuracy when compared to visual interpretation alone. CONCLUSION 99m Tc-sestamibi SPECT/CT is a non-invasive technique with good accuracy in determining if a SRM is benign or malignant.
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Affiliation(s)
- Pravin Viswambaram
- UWA Medical School, University of Western Australia, Crawley, WA, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia.,Australia and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, NSW, Australia
| | | | | | - Kevin Pham
- Liverpool Hospital, Sydney, NSW, Australia
| | | | - Dickon Hayne
- UWA Medical School, University of Western Australia, Crawley, WA, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia.,Australia and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, NSW, Australia
| | - Akhil Hamid
- Fiona Stanley Hospital, Murdoch, WA, Australia
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13
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:ijms23052603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence:
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The value of sestamibi single-photon emission computed tomography/computed tomography in differentiating and staging renal cell carcinomas. Curr Urol 2022; 16:32-37. [PMID: 35633856 PMCID: PMC9132183 DOI: 10.1097/cu9.0000000000000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Misdiagnosis of benign renal neoplasms can lead to unnecessary surgical resections, which increases the risk of other morbidities and mortality. Therefore, it is crucial to find a diagnostic modality for differentiation between benign and malignant renal masses. In the current study, we summarized published pieces of evidence concerning the use of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) as a promising diagnostic nuclear imaging modality for the differentiation of renal neoplasms. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for Systematic Reviews and Meta-Analyses. We conducted a systematic electronic database search for suitable studies from inception till February 20, 2020 in 9 databases. The risk of bias was assessed for the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We identified 9373 records after exclusion of 8978 duplicates using EndNote software. Title and abstract screening resulted in 761 records for further full-text screening. Finally, four studies were included with total sample size of 80 patients. The overall risk of bias was low to moderate. The results of all the included studies supported using 99mTc-sestamibi SPECT/CT for the differentiation between benign and malignant renal neoplasms. The use of 99mTc-sestamibi SPECT/CT could be a rapid, less invasive, promising diagnostic modality for histological diagnosis and staging of renal neoplasm, as well as monitoring post-therapy tumor's response. However, more studies with large sample sizes are essential to confirm the reliability and accuracy of this modality for usage.
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15
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Zhao Q, Dong A, Ye H, Zuo C. 99mTc-MIBI SPECT/CT and FDG PET/CT in Isolated Bilateral Renal Metastases From Adenoid Cystic Carcinoma of the Maxilla. Clin Nucl Med 2022; 47:e205-e207. [PMID: 35006121 DOI: 10.1097/rlu.0000000000003872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT Renal metastasis from adenoid cystic carcinoma of the head and neck is uncommon. We present 99mTc-MIBI SPECT/CT and FDG PET/CT findings in a case with isolated bilateral renal metastases from adenoid cystic carcinoma of the left maxilla. The metastatic adenoid cystic carcinomas of the kidneys showed photopenia on 99mTc-MIBI SPECT/CT and increased FDG uptake on FDG PET/CT mimicking primary renal cell carcinoma.
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Affiliation(s)
- Qian Zhao
- From the Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | | | - Huamao Ye
- Urology, Changhai Hospital, Navy Medical University, Shanghai, China
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16
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Lyske J, Mathew RP, Hutchinson C, Patel V, Low G. Multimodality imaging review of focal renal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Focal lesions of the kidney comprise a spectrum of entities that can be broadly classified as malignant tumors, benign tumors, and non-neoplastic lesions. Malignant tumors include renal cell carcinoma subtypes, urothelial carcinoma, lymphoma, post-transplant lymphoproliferative disease, metastases to the kidney, and rare malignant lesions. Benign tumors include angiomyolipoma (fat-rich and fat-poor) and oncocytoma. Non-neoplastic lesions include infective, inflammatory, and vascular entities. Anatomical variants can also mimic focal masses.
Main body of the abstract
A range of imaging modalities are available to facilitate characterization; ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET), each with their own strengths and limitations. Renal lesions are being detected with increasing frequency due to escalating imaging volumes. Accurate diagnosis is central to guiding clinical management and determining prognosis. Certain lesions require intervention, whereas others may be managed conservatively or deemed clinically insignificant. Challenging cases often benefit from a multimodality imaging approach combining the morphology, enhancement and metabolic features.
Short conclusion
Knowledge of the relevant clinical details and key imaging features is crucial for accurate characterization and differentiation of renal lesions.
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Gong J, Dong A, Shao C. Metanephric Adenoma Mimicking Renal Cell Carcinoma on 99mTc-MIBI SPECT/CT. Clin Nucl Med 2021; 46:759-760. [PMID: 33826579 DOI: 10.1097/rlu.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Metanephric adenoma is a rare benign renal tumor. A 49-year-old woman presented with a left renal pelvic mass detected by ultrasound. Enhanced CT of the kidney showed slight enhancement of the mass. For characterization of the mass, 99mTc-MIBI SPECT/CT was performed showing photopenia of the mass. Renal cell carcinoma was suspected. The mass was removed surgically. Metanephric adenoma was confirmed by histopathology. This case indicates that metanephric adenoma can appear cold on 99mTc-MIBI SPECT/CT, mimicking renal cell carcinoma.
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Affiliation(s)
| | - Aisheng Dong
- Nuclear Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
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18
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A 25-year perspective on evaluation and understanding of biomarkers in urologic cancers. Urol Oncol 2021; 39:602-617. [PMID: 34315659 DOI: 10.1016/j.urolonc.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022]
Abstract
The past 25 years have witnessed an explosion of investigative attempts to identify clinically useful biomarkers which can have meaningful impacts for patients with urologic cancers. However, in spite of the enormous amount of research aiming to identify markers with the hope of impacting patient care, only a handful have proven to have true clinical utility. Improvements in targeted imaging, pan-omics evaluation, and genetic sequencing at the tissue and single-cell levels have yielded many potential targets for continued biomarker investigation. This article, as one in this series for the 25th Anniversary Issue of Urologic Oncology: Seminars and Original Investigations, serves to give a perspective on our progress and failures over the past quarter-century in our highest volume urologic cancers: prostate, bladder, and kidney cancers.
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England RW, Sheikhbahaei S, Solomon AJ, Arbab-Zadeh A, Solnes LB, Bronner J, Johnson PT. When More Is Better: Underused Advanced Imaging Exams That Can Improve Outcomes and Reduce Cost of Care. Am J Med 2021; 134:848-853.e1. [PMID: 33819488 DOI: 10.1016/j.amjmed.2021.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022]
Abstract
Appropriate use of resources is a tenet of care transformation efforts, with a national campaign to reduce low-value imaging. The next level of performance improvement is to bolster evidence-based screening, imaging surveillance, and diagnostic innovation, which can avert more costly, higher-risk elements of unnecessary care like emergent interventions. Clinical scenarios in which underused advanced imaging can improve outcomes and reduce total cost of care are reviewed, including abdominal aortic aneurysm surveillance, coronary artery disease diagnosis, and renal mass characterization. Reliable abdominal aortic aneurysm surveillance imaging reduces emergency surgery and can be driven by radiologists incorporating best practice standardized recommendations in imaging interpretations. Coronary computed tomography angiography in patients with stable and unstable chest pain can reduce downstream resource use while improving outcomes. Preoperative 99mTc-sestamibi single-photon emission computed tomography (SPECT) reliably distinguishes oncocytoma from renal cell carcinoma to obviate unnecessary nephrectomy. As technological advances in diagnostic, molecular, and interventional radiology improve our ability to detect and cure disease, analyses of cost effectiveness will be critical to radiology leadership and sustainability in the transition to a value-based reimbursement model.
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Affiliation(s)
| | | | | | - Armin Arbab-Zadeh
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Jay Bronner
- Radiology Partners Research Institute, El Segundo, Calif
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20
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Zheng Y, Wang S, Chen Y, Du HQ. Deep learning with a convolutional neural network model to differentiate renal parenchymal tumors: a preliminary study. Abdom Radiol (NY) 2021; 46:3260-3268. [PMID: 33656574 DOI: 10.1007/s00261-021-02981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE With advancements in medical imaging, more renal tumors are detected early, but it remains a challenge for radiologists to accurately distinguish subtypes of renal parenchymal tumors. We aimed to establish a novel deep convolutional neural network (CNN) model and investigate its effect on identifying subtypes of renal parenchymal tumors in T2-weighted fat saturation sequence magnetic resonance (MR) images. METHODS This retrospective study included 199 patients with pathologically confirmed renal parenchymal tumors, including 77, 46, 34, and 42 patients with clear cell renal cell carcinoma (ccRCC), chromophobe renal cell carcinoma (chRCC), angiomyolipoma (AML), and papillary renal cell carcinoma (pRCC), respectively. All enrolled patients underwent kidney MR scans with the field strength of 1.5 Tesla (T) or 3.0 T before surgery. We selected T2-weighted fat saturation sequence images of all patients and built a deep learning model to determine the type of renal tumors. Receiver operating characteristic (ROC) curve was depicted to estimate the performance of the CNN model; the accuracy, precision, sensitivity, specificity, F1-score, and area under the curve (AUC) were calculated. One-way analysis of variance and χ2 tests of independent samples were used to analyze the variables. RESULTS The experimental results demonstrated that the model had a 60.4% overall accuracy, a 61.7% average accuracy, and a macro-average AUC of 0.82. The AUCs for ccRCC, chRCC, AML, and pRCC were 0.94, 0.78, 0.80, and 0.76, respectively. CONCLUSION Deep CNN model based on T2-weighted fat saturation sequence MR images was useful to classify the subtypes of renal parenchymal tumors with a relatively high diagnostic accuracy.
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Affiliation(s)
- Yao Zheng
- Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuai Wang
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China
| | - Yan Chen
- Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Hui-Qian Du
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China.
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21
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Su ZT, Patel HD, Huang MM, Meyer AR, Pavlovich CP, Pierorazio PM, Javadi MS, Allaf ME, Rowe SP, Gorin MA. Cost-effectiveness Analysis of 99mTc-sestamibi SPECT/CT to Guide Management of Small Renal Masses. Eur Urol Focus 2021; 7:827-834. [DOI: 10.1016/j.euf.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 01/20/2023]
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22
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Kirkland JW, Zhao JM, McWhorter NE, Banks KP. Parotid Oncocytoma on 99mTc-Sestamibi Scintigraphy and SPECT/CT. Clin Nucl Med 2021; 46:480-482. [PMID: 33512956 DOI: 10.1097/rlu.0000000000003527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Oncocytomas in the parotid gland are a rare benign neoplasm composed of mitochondrial-rich oncocytes. Here we present the case of an 85-year-old man with a history of biopsy-proven right parotid gland oncocytoma who underwent 99mTc-sestamibi scintigraphy and SPECT/CT in the context of primary hyperparathyroidism. Focal intense uptake of radiotracer is detected within the right parotid gland on sestamibi scintigraphy. SPECT/CT confirms the localization of sestamibi uptake to the hyperattenuating parotid gland oncocytoma.
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Affiliation(s)
| | - Jason M Zhao
- San Antonio Military Medical Center, San Antonio, TX
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23
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Warren H, Neves JB, Tran MGB. Renal oncocytoma: landscape of diagnosis and management. BJU Int 2021; 128:685-687. [PMID: 34036709 DOI: 10.1111/bju.15496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/20/2021] [Accepted: 05/13/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Hannah Warren
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
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24
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Alkordy T, Wang S, Price M, Stodilka R, Warrington J, Vezina W, Laidley D, Nelli S, Akincioglu C, Romsa J. Evaluation of an incidental solid renal mass during cardiac Tc-99m MIBI SPECT/CT imaging. J Nucl Cardiol 2021; 28:760-762. [PMID: 32076960 DOI: 10.1007/s12350-020-02037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Turki Alkordy
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
- Directorate of Health Affairs-Jeddah, Ministry of Health, Jeddah, Saudi Arabia
| | - Shengnan Wang
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - Martina Price
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - Robert Stodilka
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - James Warrington
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - William Vezina
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - David Laidley
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - Stephen Nelli
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada
| | - Jonathan Romsa
- Division of Nuclear Medicine, Department of Medical Imaging, London Health Sciences Centre, London, Canada.
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25
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In Situ Metabolomics Expands the Spectrum of Renal Tumours Positive on 99mTc-sestamibi Single Photon Emission Computed Tomography/Computed Tomography Examination. EUR UROL SUPPL 2020; 22:88-96. [PMID: 34337482 PMCID: PMC8317898 DOI: 10.1016/j.euros.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Definite noninvasive characterisation of renal tumours positive on 99mTc-sestamibi single photon emission computed tomography/computed tomography (SPECT/CT) examination including renal oncocytomas (ROs), hybrid oncocytic chromophobe tumours (HOCTs), and chromophobe renal cell carcinoma (chRCC) is currently not feasible. Objective To investigate whether combined 99mTc-sestamibi SPECT/CT and in situ metabolomic profiling can accurately characterise renal tumours exhibiting 99mTc-sestamibi uptake. Design, setting, and participants A tissue microarray analysis of 33 tumour samples from 28 patients was used to investigate whether their in situ metabolomic status correlates with their features on 99mTc-sestamibi SPECT/CT examination. In order to validate emerging data, an independent cohort comprising 117 tumours was subjected to matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI MSI). Outcome measurements and statistical analysis MALDI MSI data analysis and image generation were facilitated by FlexImaging v. 4.2, while k-means analysis by SCiLS Lab software followed by R-package CARRoT analysis was used for assessing the highest predictive power in the differential of RO versus chRCC. Heatmap-based clustering, sparse partial least-squares discriminant analysis, and volcano plots were created with MetaboAnalyst 3.0. Results and limitations We identified a discriminatory metabolomic signature for 99mTc-sestamibi SPECT/CT–positive Birt-Hogg-Dubè–associated HOCTs versus other renal oncocytic tumours. Metabolomic differences were also evident between 99mTc-sestamibi–positive and 99mTc-sestamibi–negative chRCCs, prompting additional expert review; two of three 99mTc-sestamibi–positive chRCCs were reclassified as low-grade oncocytic tumours (LOTs). Differences were identified between distal-derived tumours from those of proximal tubule origin, including differences between ROs and chRCCs. Conclusions The current study expands the spectrum of 99mTc-sestamibi SPECT/CT–positive renal tumours, encompassing ROs, HOCTs, LOTs, and chRCCs, and supports the feasibility of in situ metabolomic profiling in the diagnostics and classification of renal tumours. Patient summary For preoperative evaluation of solid renal tumours, 99mTc-sestamibi single photon emission computed tomography/computed tomography (SPECT/CT) is a novel examination method. To increase diagnostic accuracy, we propose that 99mTc-sestamibi–positive renal tumours should be biopsied and followed by a combined histometabolomic analysis.
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Sistani G, Bjazevic J, Kassam Z, Romsa J, Pautler S. The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses. Can Urol Assoc J 2020; 15:197-201. [PMID: 33212002 DOI: 10.5489/cuaj.6708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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.
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Affiliation(s)
| | | | - Zahra Kassam
- London Health Sciences Centre, London, ON, Canada
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27
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Dual-Phase 99mTc-MIBI SPECT/CT in the Characterization of Enhancing Solid Renal Tumors: A Single-Institution Study of 147 Cases. Clin Nucl Med 2020; 45:765-770. [PMID: 32701813 DOI: 10.1097/rlu.0000000000003212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to investigate the value of dual-phase Tc-MIBI SPECT/CT in the differential diagnosis between benign and malignant enhancing solid renal tumors. PATIENTS AND METHODS Totally, 180 patients were imaged with dual-phase Tc-MIBI SPECT/CT, which was performed 30 minutes and 90 minutes after Tc-MIBI administration. Among them, 147 patients with 148 histologically proved solid renal tumors met the selection criteria and were included for the final analysis. Relative quantification was performed by measuring the radioactive uptake ratio of tumor to the normal renal parenchymal background for both early and delayed images. RESULTS Benign renal tumors (4 renal oncocytomas and 8 lipid-poor angiomyolipomas) demonstrated a significantly higher early relative uptake value (ERUV) and delayed relative uptake value (DRUV) than malignant renal tumors (n = 136; both P < 0.0001). The ERUV cutoff value of 0.53 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 94.8%, and accuracy of 95.3% for the diagnosis of benign renal tumors. The DRUV cutoff value of 0.50 helped to differentiate benign from malignant renal tumors, with sensitivity of 100%, specificity of 96.3%, and accuracy of 96.6% for the diagnosis of benign renal tumors. There was no statistically significant difference between the efficacy of ERUV and DRUV in the differential diagnosis between benign and malignant renal tumors (P = 0.5). The efficacies of ERUV and DRUV were all significantly higher than the retention index (both P < 0.0001). CONCLUSIONS Both early and delayed phase Tc-MIBI SPECT/CT are helpful for distinguishing benign renal oncocytoma and lipid-poor angiomyolipoma from malignant renal tumors, and the delayed phase imaging tends to show higher diagnostic accuracy.
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Wang ZJ, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Goldfarb S, Gore JL, Gupta RT, Hartman RP, Heilbrun ME, Lyshchik A, Purysko AS, Savage SJ, Smith AD, Wolfman DJ, Wong-You-Cheong JJ, Lockhart ME. ACR Appropriateness Criteria® Indeterminate Renal Mass. J Am Coll Radiol 2020; 17:S415-S428. [PMID: 33153554 DOI: 10.1016/j.jacr.2020.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Abstract
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. CT and MRI with intravenous contrast and a dedicated multiphase protocol are the mainstays of evaluation for indeterminate renal masses. A single-phase postcontrast dual-energy CT can be useful when a dedicated multiphase renal protocol CT is not available. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MRI contrast is contraindicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California.
| | | | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Darcy J Wolfman
- Johns Hopkins University School of Medicine, Washington, District of Columbia
| | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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The role of Tc-99m MIBI scintigraphy in clinical T1 renal mass assessment: Does it have a real benefit? Urol Oncol 2020; 38:937.e11-937.e17. [PMID: 32859460 DOI: 10.1016/j.urolonc.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Despite the increasing accuracy of imaging modalities, the rate of benign renal tumors misclassified as malignant before surgery still non-negligible. Tc-99m sestamibi was demonstrated to be a possible reliable agent in discriminating oncocytoma from renal cell carcinoma (RCC). We aimed to study the efficacy of Tc-99m MIBI tumor scintigraphy in evaluating clinical T1 renal masses. METHODS AND MATERIALS Between July 2017 and March 2019, patients with clinical T1 renal mass underwent preoperative Tc-99m sestamibi tumor scintigraphy. Tc-99m sestamibi tumor scintigraphy findings were correlated with the postoperative pathology results. RESULTS A total of 90 renal masses were included in the study. Male to female ratio was 67/23. The mean age and tumor size were 55.5 ± 11.4 years and 4 ± 1.4 cm, respectively. In pathological evaluation, 20% (18/90) of masses were reported as benign (10 oncocytomas, 4 angiomyolipomas (AML), 2 chronic sclerosis, 1 fibroma and 1 hydatid cyst). While Tc-99m sestamibi uptake was positive in all oncocytomas; 6 patients with chronic sclerosis, fibroma, hydatid cyst and angiomyolipoma pathologies had no uptake. Except for 5 chromophobe cell RCC and 3 oncocytic papillary RCC masses, malignant lesions had no uptake. In predicting benign pathology, Tc-99m sestamibi tumor scintigraphy had positive and negative predictive value of 60% and 91.3%, respectively. The mean Tc-99m 2-methoxy isobutyl isonitrile lesion/normal renal parenchyma ratio of benign and malignant lesions was 0.6 and 0.37, respectively. A relative uptake of 0.49 was an acceptable cutoff point to discriminate oncocytomas from all other pathologies. CONCLUSION Tc-99m sestamibi tumor scintigraphy has a beneficial role in the assessment of clinical T1 renal mass. Masses with negative uptake harbor high probability of being malignant. While evaluating masses with positive uptake, it should be kept in mind that some malignant pathologies may demonstrate similar results.
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Wilson MP, Katlariwala P, Murad MH, Abele J, McInnes MDF, Low G. Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis. Abdom Radiol (NY) 2020; 45:2532-2541. [PMID: 32193593 DOI: 10.1007/s00261-020-02469-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The primary objectives of this systematic review and meta-analysis were to evaluate the diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytoma versus (1) all other renal lesions and (2) chromophobe renal cell carcinoma (ChrRCC) alone. METHODS A systematic review of MEDLINE, EMBASE, Scopus, the Cochrane Library, and the Gray Literature was performed. Original articles with > 5 patients evaluating oncocytomas versus other renal lesions with SPECT/CT using a pathological reference standard were included. Patient, clinical, imaging, and performance parameters were independently acquired by two reviewers. Meta-analysis was performed using a bivariate mixed-effects regression model. RESULTS Four articles with a total of 117 renal lesions were included in analysis. The pooled and weighted sensitivity and specificity values of 99mTc-sestamibi SPECT/CT for detecting (1) renal oncocytoma versus other renal lesions were 92% (95% CI 72-98%) and 88% (95% CI 79-94%), respectively, and (2) 89% and 67%, respectively, for renal oncocytoma versus ChrRCC. The specificity for the detecting the oncocytoma-ChrRCC spectrum was 96% (95% CI 84-99%). The sensitivity and specificity for detecting benign versus malignant renal lesions were 86% (95% CI 66-95%) and 90% (95% CI 80-95%), and 88% and 95% when HOCTs were characterized as benign. All reporting studies used a cut-off tumor-to-background renal parenchyma radiotracer uptake ratio of > 0.6 for positive studies. CONCLUSION 99mTc-sestamibi SPECT/CT demonstrates a high sensitivity and specificity for characterizing benign and low-grade renal lesions. This test can help improve the diagnostic confidence for patients with indeterminate renal masses being considered for active surveillance.
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Urbano N, Scimeca M, Di Russo C, Mauriello A, Bonanno E, Schillaci O. [ 99mTc]Sestamibi SPECT Can Predict Proliferation Index, Angiogenesis, and Vascular Invasion in Parathyroid Patients: A Retrospective Study. J Clin Med 2020; 9:jcm9072213. [PMID: 32668651 PMCID: PMC7408803 DOI: 10.3390/jcm9072213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to evaluate the possible association among sestamibi uptake and the main histopathological characteristics of parathyroid lesions related to aggressiveness such as the proliferation index (Ki67 expression and mitosis), angiogenesis (number of vessels), and vascular invasion in hyperparathyroidism patients. To this end, 26 patients affected by primary hyperparathyroidism subjected to both scintigraphy with [99mTc]Sestamibi and surgery/bioptic procedure were retrospectively enrolled. Hyperfunctioning of the parathyroid was detected in 19 patients. Our data showed a significant positive association among the sestamibi uptake and the proliferation index histologically evaluated both in terms of the number of Ki67 positive cells and mitosis. According to these data, lesions with a higher valuer of L/N (lesion to nonlesion ratio) frequently showed several vessels in tumor areas and histological evidence of vascular invasion. It is noteworthy that among patients with negative scintigraphy, 2 patients showed a neoplastic lesion after surgery (histological analysis). However, it is important to highlight that these lesions displayed very low proliferation indexes, which was evaluated in terms of number of both mitosis and Ki67-positive cells, some/rare vessels in the main lesion, and no evidence of vascular invasion. In conclusion, data obtained on patients with positive or negative scintigraphy support the hypothesis that sestamibi can be a tracer that is capable of predicting some biological characteristics of parathyroid tumors such as angiogenesis, proliferation indexes, and the invasion of surrounding tissues or vessels.
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Affiliation(s)
- Nicoletta Urbano
- Nuclear Medicine Unit, Department of Oncohaematology, Policlinico “Tor Vergata”, 00133 Rome, Italy; (N.U.); (C.D.R.)
| | - Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy
- Saint Camillus International University of Health Sciences, Via di Sant’Alessandro, 8, 00131 Rome, Italy
| | - Carmela Di Russo
- Nuclear Medicine Unit, Department of Oncohaematology, Policlinico “Tor Vergata”, 00133 Rome, Italy; (N.U.); (C.D.R.)
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (E.B.)
| | - Elena Bonanno
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (A.M.); (E.B.)
- Diagnostica Medica’ & ‘Villa dei Platani’, Neuromed Group, 83100 Avellino, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- IRCCS Neuromed, Via Atinense, 18, 8607 Pozzilli, Italy
- Correspondence: ; Tel.: +39-06-2090-2419
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Abdessater M, Kanbar A, Comperat E, Dupont-Athenor A, Alechinsky L, Mouton M, Sebe P. Renal Oncocytoma: An Algorithm for Diagnosis and Management. Urology 2020; 143:173-180. [PMID: 32512107 DOI: 10.1016/j.urology.2020.05.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/23/2020] [Accepted: 05/16/2020] [Indexed: 12/18/2022]
Abstract
Renal oncocytoma is an uncommon tumor that exhibits numerous features which are characteristic but not necessarily unique. Percutaneous biopsy is a safe method of diagnosis. However, differentiation from other tumor subtypes often requires sophisticated analysis and is not universally feasible. This is why, surgical management can be considered as a first-line treatment or after surveillance. Potential triggers for change in management are: tumor size >3 cm, stage progression, kinetics of size progression (>5 mm/y), and clinical change in patient or tumor factors. Long-term follow-up data are lacking and greater centralization should be considered to reach adequate management.
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Affiliation(s)
- Maher Abdessater
- Department of Urology and Renal Transplantation, APHP - Pitié Salpêtrière University Hospital, Paris, France; Department of Urology, Hospital Group Diaconesses Croix Saint-Simon, Paris, France.
| | - Anthony Kanbar
- Department of Urology, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | - Eva Comperat
- Department of Pathology, APHP - Tenon Hospital, Paris, France
| | | | - Louise Alechinsky
- Department of Urology and Renal Transplantation, APHP - Pitié Salpêtrière University Hospital, Paris, France; Department of Urology, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | - Martin Mouton
- Department of Urology, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | - Philippe Sebe
- Department of Urology, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
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Tzortzakakis A, Holstensson M, Hagel E, Karlsson M, Axelsson R. Intra- and Interobserver Agreement of SUV SPECT Quantitative SPECT/CT Processing Software, Applied in Clinical Settings for Patients with Solid Renal Tumors. J Nucl Med Technol 2019; 47:258-262. [PMID: 31019039 DOI: 10.2967/jnmt.118.223297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/31/2019] [Indexed: 01/10/2023] Open
Abstract
Quantification tools for SPECT/CT are a field of ongoing research among hybrid imaging techniques. A recent multicenter study evaluating SUV SPECT software on phantoms showed that quantitative SPECT/CT is reproducible in Hybrid Viewer software. The aim of our study was to evaluate the intra- and interobserver agreement of quantitative SUV SPECT measurements in clinical settings for patients with solid renal tumors. Methods: The evaluation was part of a study that examined the role of 99mTc-sestamibi SPECT/CT in the characterization of solid kidney tumors and the differentiation of renal oncocytomas from renal cell carcinomas. Quantitative evaluation of SUV measurements was performed in Hybrid Viewer PDR, version 2.5. Forty-eight renal lesions were identified and examined twice by 2 independent readers. The agreement of the SUV measurements, concerning renal tumors and adjacent renal parenchyma, was evaluated using the intraclass correlation coefficient (ICC). Results: ICC for SUVmax measurements by the same reader was 97%-99% for solid renal tumors and 92%-98% for ipsilateral healthy renal parenchyma. ICC for SUVmax measurements between readers was 87%-89% for solid renal tumors and 72%-73% for ipsilateral healthy renal parenchyma. Estimated ICC for SUVmean measurements of solid renal tumors was 95%-98% for the same reader and 86%-89% between readers. Similar results were found for SUVpeak measurements. Conclusion: The high ICCs indicate a strong agreement among SUV measurements for patients with solid renal lesions undergoing 99mTc-sestamibi SPECT/CT, not only for measurements by the same reader but also for measurements between 2 different readers.
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Affiliation(s)
- Antonios Tzortzakakis
- Division of Radiology, Department for Clinical Science, Intervention, and Technology, Karolinska Institutet and Medical Physics and Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden .,Division of Medical Imaging and Technology, Department of Neuroradiology, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Holstensson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden; and
| | - Eva Hagel
- Learning, Informatics, Management, and Ethics, Medical Statistics Unit, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Karlsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden; and
| | - Rimma Axelsson
- Division of Radiology, Department for Clinical Science, Intervention, and Technology, Karolinska Institutet and Medical Physics and Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden; and
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Abstract
OBJECTIVE. Renal masses comprise a heterogeneous group of pathologic conditions, including benign and indolent diseases and aggressive malignancies, complicating management. In this article, we explore the emerging role of imaging to provide a comprehensive noninvasive characterization of a renal mass-so-called "virtual biopsy"-and its potential use in the management of patients with renal tumors. CONCLUSION. Percutaneous renal mass biopsy (RMB) remains a valuable method to provide a presurgical histopathologic diagnosis of renal masses, but it is an invasive procedure and is not always feasible. Accumulating data support the use of imaging features to predict histopathology of renal masses. Imaging may help address some of the inherent limitations of RMB, and in certain settings, a multimodal clinical approach may allow decreasing the need for RMB.
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35
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Graybiel CE, Flavell RR, Wang ZJ, Behr SC. Molecular Imaging of Renal Malignancy: A Review. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Using Aorta-Lesion-Attenuation Difference on Preoperative Contrast-enhanced Computed Tomography Scan to Differentiate Between Malignant and Benign Renal Tumors. Urology 2019; 125:123-130. [DOI: 10.1016/j.urology.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
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Campbell SP, Tzortzakakis A, Javadi MS, Karlsson M, Solnes LB, Axelsson R, Allaf ME, Gorin MA, Rowe SP. 99mTc-sestamibi SPECT/CT for the characterization of renal masses: a pictorial guide. Br J Radiol 2018; 91:20170526. [PMID: 29271233 DOI: 10.1259/bjr.20170526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In parallel to the increased utilization of cross-sectional imaging, the incidence of small renal masses has steadily risen in recent years. At the present time, anatomical imaging techniques are limited in their ability to differentiate benign from malignant renal masses. Moreover, renal mass biopsy has a high non-diagnostic rate, poor negative-predictive ability, and carries potential risks as well as substantial costs. As a result, benign renal masses are often unnecessarily resected for the false presumption of cancer. 99mTc-sestamibi single photon emission computed tomography/computed tomography (SPECT/CT) is a molecular imaging test that allows for the differentiation of benign renal oncocytomas and hybrid oncocytomic/chromophobe tumours apart from malignant renal cell carcinomas on the basis of differences in mitochondrial content as well as multidrug resistant pump expression. Herein, we review the principles of 99mTc-sestamibi SPECT/CT administration and image interpretation for the purpose of renal mass characterization.
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Affiliation(s)
- Scott P Campbell
- 1 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Antonios Tzortzakakis
- 2 Department of Clinical Science, Intervention, and Technology, Imaging and Function, Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden
| | - Mehrbod S Javadi
- 3 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Mattias Karlsson
- 4 Imaging and Function, Medical Physics and Nuclear Medicine, Karolinska University Hospital , Stockholm , Sweden
| | - Lilja B Solnes
- 3 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Rimma Axelsson
- 5 Department of Clinical Science, Intervention, and Technology, Imaging and Function, Medical Physics and Nuclear Medicine, Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden
| | - Mohamad E Allaf
- 1 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Michael A Gorin
- 1 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| | - Steven P Rowe
- 1 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine , Baltimore, MD , USA.,3 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, MD , USA
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40
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Sasaguri K, Takahashi N. CT and MR imaging for solid renal mass characterization. Eur J Radiol 2017; 99:40-54. [PMID: 29362150 DOI: 10.1016/j.ejrad.2017.12.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/04/2017] [Accepted: 12/09/2017] [Indexed: 12/15/2022]
Abstract
As our understanding has expanded that relatively large fraction of incidentally discovered renal masses, especially in small size, are benign or indolent even if malignant, there is growing acceptance of more conservative management including active surveillance for small renal masses. As for advanced renal cell carcinomas (RCCs), nonsurgical and subtype specific treatment options such as immunotherapy and targeted therapy is developing. On these backgrounds, renal mass characterization including differentiation of benign from malignant tumors, RCC subtyping and prediction of RCC aggressiveness is receiving much attention and a variety of imaging techniques and analytic methods are being investigated. In addition to conventional imaging techniques, integration of texture analysis, functional imaging (i.e. diffusion weighted and perfusion imaging) and multivariate diagnostic methods including machine learning have provided promising results for these purposes in research fields, although standardization and external, multi-institutional validations are needed.
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Affiliation(s)
- Kohei Sasaguri
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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41
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Jones KM, Solnes LB, Rowe SP, Gorin MA, Sheikhbahaei S, Fung G, Frey EC, Allaf ME, Du Y, Javadi MS. Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses. Ann Nucl Med 2017; 32:87-93. [PMID: 29214562 DOI: 10.1007/s12149-017-1222-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has previously been shown to allow for the accurate differentiation of benign renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) apart from other malignant renal tumor histologies, with oncocytomas/HOCTs showing high uptake and renal cell carcinoma (RCC) showing low uptake based on uptake ratios from non-quantitative single-photon emission computed tomography (SPECT) reconstructions. However, in this study, several tumors fell close to the uptake ratio cutoff, likely due to limitations in conventional SPECT/CT reconstruction methods. We hypothesized that application of quantitative SPECT/CT (QSPECT) reconstruction methods developed by our group would provide more robust separation of hot and cold lesions, serving as an imaging framework on which quantitative biomarkers can be validated for evaluation of renal masses with 99mTc-sestamibi. METHODS Single-photon emission computed tomography data were reconstructed using the clinical Flash 3D reconstruction and QSPECT methods. Two blinded readers then characterized each tumor as hot or cold. Semi-quantitative uptake ratios were calculated by dividing lesion activity by background renal activity for both Flash 3D and QSPECT reconstructions. RESULTS The difference between median (mean) hot and cold tumor uptake ratios measured 0.655 (0.73) with the QSPECT method and 0.624 (0.67) with the conventional method, resulting in increased separation between hot and cold tumors. Sub-analysis of 7 lesions near the separation point showed a higher absolute difference (0.16) between QPSECT and Flash 3D mean uptake ratios compared to the remaining lesions. CONCLUSIONS Our finding of improved separation between uptake ratios of hot and cold lesions using QSPECT reconstruction lays the foundation for additional quantitative SPECT techniques such as SPECT-UV in the setting of renal 99mTc-sestamibi and other SPECT/CT exams. With robust quantitative image reconstruction and biomarker analysis, there may be an expanded role for SPECT/CT imaging in renal masses and other pathologic conditions.
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Affiliation(s)
- Krystyna M Jones
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Lilja B Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Michael A Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Sara Sheikhbahaei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - George Fung
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Eric C Frey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Yong Du
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
| | - Mehrbod S Javadi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA
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42
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Almassi N, Gorin MA, Purysko AS, Rowe SP, Kaouk J, Allaf ME, Campbell SC, Rhee A. Use of 99mTc-sestamibi Single-photon Emission Computed Tomography / X-ray Computed Tomography in the Diagnosis of Hybrid Oncocytic / Chromophobe Tumor in a Pediatric Patient. Urology 2017; 113:206-208. [PMID: 29174943 DOI: 10.1016/j.urology.2017.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/19/2017] [Accepted: 11/11/2017] [Indexed: 01/06/2023]
Abstract
The differential diagnosis of solid renal neoplasms in adolescence includes aggressive malignancy and indolent oncocytic tumors, which are typically indistinguishable using conventional imaging. We report the use of 99mTc-sestamibi single-photon emission computed tomography / x-ray computed tomography (SPECT/CT) in characterizing enhancing renal neoplasms in a pediatric patient. Genetic testing suggested a hereditary syndrome associated with aggressive malignancy, whereas renal mass biopsy suggested an oncocytic tumor. 99mTc-sestamibi SPECT/CT indicated probable oncocytomas or hybrid oncocytic / chomophobe tumors. Enucleative resection was performed with final pathology demonstrating hybrid oncocytic / chomophobe tumors. This case highlights the potential utility of 99mTc-sestamibi SPECT/CT in characterizing indeterminate enhancing renal neoplasm in pediatric patients.
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Affiliation(s)
- Nima Almassi
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrei S Purysko
- Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Steven P Rowe
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD; The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven C Campbell
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Audrey Rhee
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Rowe SP, Gorin MA, Solnes LB, Ball MW, Choudhary A, Pierorazio PM, Epstein JI, Javadi MS, Allaf ME, Baras AS. Correlation of 99mTc-sestamibi uptake in renal masses with mitochondrial content and multi-drug resistance pump expression. EJNMMI Res 2017; 7:80. [PMID: 28971329 PMCID: PMC5624857 DOI: 10.1186/s13550-017-0329-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 11/23/2022] Open
Abstract
Background 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has recently been explored for the characterization of indeterminate renal masses. As judged by increased intra-tumoral radiotracer uptake, we have previously reported the excellent diagnostic performance characteristics of this test for identifying benign/indolent oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs). In this study, we investigated potential molecular mechanisms underlying the discriminatory ability of 99mTc-sestamibi SPECT/CT for renal masses. Fifty renal masses imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection were evaluated by immunohistochemistry for mitochondrial content and expression of the multi-drug resistance pump 1 (MDR1/P-gp). Immunohistochemical staining was scored semi-quantitatively, and results were compared across renal tumor histologies and correlated with 99mTc-sestamibi uptake. Results In total, 6/6 (100%) and 2/2 (100%) HOCTs demonstrated strong mitochondrial content staining combined with low MDR1 staining. Clear cell renal cell carcinoma showed an opposite pattern with the majority having low mitochondrial (14/26, 54%) and high MDR1 staining (18/26, 69%). Other tumor types were more variable in staining pattern, although the staining pattern reliably predicted 99mTc-sestamibi uptake in almost all tumors except chromophobe renal cell carcinoma. Conclusions Our findings confirm that renal tumors with high mitochondrial content and relatively low MDR pump expression activity accumulate 99mTc-sestamibi and allow for the accurate diagnosis of the benign/indolent tumor class that includes oncocytomas and HOCTs. For masses in which MDR activity outweighs the presence of mitochondria, the tumors appear cold on 99mTc-sestamibi SPECT/CT, allowing for high confidence in the diagnosis of renal cell carcinoma.
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Affiliation(s)
- Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA. .,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Michael A Gorin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA.,The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilja B Solnes
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ajuni Choudhary
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mehrbod S Javadi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alex S Baras
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Reynolds AM, Porter KK. Characterizing Indeterminate Renal Masses with Molecular Imaging: the Role of 99mTc-MIBI SPECT/CT. Curr Urol Rep 2017; 18:86. [DOI: 10.1007/s11934-017-0737-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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45
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Rowe SP, Javadi MS, Allaf ME, Gorin MA. Characterization of indeterminate renal masses with molecular imaging: how do we turn potential into reality? EJNMMI Res 2017; 7:34. [PMID: 28405927 PMCID: PMC5389953 DOI: 10.1186/s13550-017-0277-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA.
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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