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Warren H, Wagner T, Gorin MA, Rowe S, Holman BF, Pencharz D, El-Sheikh S, Barod R, Patki P, Mumtaz F, Bex A, Kasivisvanathan V, Moore CM, Campain N, Cartledge J, Scarsbrook A, Hassan F, O'Brien TS, Stewart GD, Mendichovszky I, Dizdarevic S, Alanbuki A, Wildgoose WH, Wah T, Vindrola-Padros C, Pizzo E, Dehbi HM, Lorgelly P, Gurusamy K, Emberton M, Tran MGB. Protocol for a MULTI-centre feasibility study to assess the use of 99mTc-sestaMIBI SPECT/CT in the diagnosis of kidney tumours (MULTI-MIBI study). BMJ Open 2023; 13:e067496. [PMID: 36693694 PMCID: PMC9884914 DOI: 10.1136/bmjopen-2022-067496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99mTc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99mTc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99mTc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial. METHODS AND ANALYSIS A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99mTc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99mTc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99mTc-sestamibi SPECT/CT. ETHICS AND DISSEMINATION Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally. TRIAL REGISTRATION NUMBER ISRCTN12572202.
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Affiliation(s)
- Hannah Warren
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Thomas Wagner
- Department of Nuclear Medicine, Royal Free Hospital, London, UK
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven Rowe
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Soha El-Sheikh
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
- Department of Pathology, Royal Free Hospital, London, UK
| | - Ravi Barod
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Faiz Mumtaz
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College Hospital, London, UK
| | - Nicholas Campain
- Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Jon Cartledge
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Scarsbrook
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fahim Hassan
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim S O'Brien
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Iosif Mendichovszky
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Nuclear Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sabina Dizdarevic
- Department of Nuclear Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Ammar Alanbuki
- Department of Urology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | | | - Tze Wah
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Cecilia Vindrola-Padros
- Rapid Research, Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, London, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Hakim-Moulay Dehbi
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paula Lorgelly
- Department of Applied Health Research, University College London, London, UK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Urology, University College Hospital, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
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