Prospective Evaluation of (99m)Tc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

Michael A Gorin; Steven P Rowe; Alexander S Baras; Lilja B Solnes; Mark W Ball; Phillip M Pierorazio; Christian P Pavlovich; Jonathan I Epstein; Mehrbod S Javadi; Mohamad E Allaf

doi:10.1016/j.eururo.2015.08.056

Prospective Evaluation of (99m)Tc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors

Eur Urol. 2016 Mar;69(3):413-6. doi: 10.1016/j.eururo.2015.08.056. Epub 2015 Sep 18.

Affiliations

¹ The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: mallaf@jhmi.edu.

PMID: 26386607
DOI: 10.1016/j.eururo.2015.08.056

Abstract

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

Patient summary: We found that the imaging test (99m)Tc-sestamibi SPECT/CT can be used to accurately diagnose two types of benign kidney tumors. This test may be eventually used to help better evaluate patients diagnosed with a renal tumor.

Keywords: (99m)Tc-sestamibi; Oncocytoma; Renal cell carcinoma; Risk stratification; Small renal mass.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adenoma, Oxyphilic / diagnostic imaging*
Aged
Carcinoma, Renal Cell / diagnostic imaging*
Diagnosis, Differential
Female
Humans
Kidney Neoplasms / diagnostic imaging*
Male
Middle Aged
Multimodal Imaging / methods*
Observer Variation
Predictive Value of Tests
Prospective Studies
Radiopharmaceuticals*
Reproducibility of Results
Technetium Tc 99m Sestamibi*
Tomography, Emission-Computed, Single-Photon*
Tomography, X-Ray Computed*

Substances

Radiopharmaceuticals
Technetium Tc 99m Sestamibi

Supplementary concepts

Oncocytoma, renal