Visual evaluation and differentiation of renal oncocytomas from renal cell carcinomas by means of 99mTc-sestamibi SPECT/CT

Abstract

BackgroundDespite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion. Approximately 10% of all solid renal tumours turn out to be oncocytomas. In actual clinical practice, this is verified only following unnecessary surgery or a renal biopsy/ablation. The objective of our pilot study examines whether 99mTc-sestamibi SPECT/CT can play a crucial role in the characterization of solid renal neoplasms and the differentiation of oncocytomas from renal cell carcinomas.The study included 27 patients identified with 31 solid renal lesions. All patients were discussed in a multidisciplinary conference, and a decision for surgery or biopsy was taken. Prior to invasive procedures, patients underwent a SPECT/CT with 99mTc-sestamibi. Visual evaluation was performed, and any focal 99mTc-sestamibi uptake detected on SPECT in the localisation of tumour was considered as positive.ResultsEleven out of 12 oncocytomas (91.6%) displayed positive uptake of 99mTc-sestamibi. Three hybrid tumours (mixed-type oncocytoma and chromophobe renal cancer) were positive on SPECT/CT. One papillary renal cell carcinoma had a slight uptake of 99mTc-sestamibi. The remaining 11 renal cell carcinomas were sestamibi negative.ConclusionsDifferentiation of benign renal oncocytomas from renal cell carcinomas seems very promising on 99mTc-sestamibi SPECT/CT examination. Additional supplement to visual evaluation, i.e. quantitative tools, should be sought for an accurate estimate of biological behaviour and hence a secure diagnosis.

[99mTc]Sestamibi SPECT Can Predict Proliferation Index, Angiogenesis, and Vascular Invasion in Parathyroid Patients: A Retrospective Study

“…The capability of sestamibi to identify malignant lesions by SPECT analysis has been shown for several human diseases such as hearth injury, breast cancer renal carcinomas, and PHP [ 29 , 30 , 31 , 32 , 33 ]. Indeed, numerous investigations demonstrated a close association between positive [ 99 mTc]Sestamibi analysis and the severity of disease [ 29 , 30 , 31 , 32 , 33 ]. However, few studies correlated the sestamibi uptake with the histopathological characteristics of human lesions [ 34 , 35 ].…”

ACR Appropriateness Criteria® Indeterminate Renal Mass

“…Tc-99m sestamibi single-photon emission computed tomography (SPECT)/CT has been shown in several studies to be helpful when the diagnosis of a renal oncocytoma is suspected [21][22][23]. For example, in a study of 31 renal masses imaged with Tc-99m sestamibi SPECT/CT, 91.6% (11 of 12) of oncocytomas had radiotracer uptake above adjacent normal renal parenchyma, 3 hybrid tumors (mixedtype oncocytoma and chromophobe renal cancer) showed tracer uptake, 1 papillary RCC had a slight tracer uptake, and the remaining 11 RCC were sestamibi negative [23].…”

Correlation of 99mTc-sestamibi uptake in renal masses with mitochondrial content and multi-drug resistance pump expression

“…Improved methods of non-invasive imaging of renal masses would allow effective risk stratification of patients presenting with these lesions [ 8 , 9 ]. Our group and others have previously demonstrated the ability of 99m Tc-sestamibi single-photon emission computed tomography (SPECT)/CT to differentiate renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal mass histologies, allowing for the non-invasive identification of these benign/indolent tumors [ 10 – 12 ]. The uptake of 99m Tc-sestamibi by oncocytomas and HOCTs is thought to derive from the high density of mitochondria in these tumors.…”