99mTc-Sestamibi SPECT/CT and histopathological features of oncocytic renal neoplasia

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.

Citation

Tzortzakakis, A., Papathomas, T., Gustafsson, O., Gabrielson, S., Trpkov, K., Ekström-Ehn, L., Arvanitis, A., Holstensson, M., Karlsson, M., Kokaraki, G., & Axelsson, R. (2022). 99mTc-Sestamibi SPECT/CT and histopathological features of oncocytic renal neoplasia. Scandinavian journal of urology, 56(5-6), 375–382. https://doi.org/10.1080/21681805.2022.2119273

DOI

10.1080/21681805.2022.2119273

URI

https://hdl.handle.net/20.500.14709/649

Usage rights

CC BY-NC-ND 4.0

License

https://creativecommons.org/licenses/by-nc-nd/4.0/