Clinical Performance of Technetium-99m-Sestamibi SPECT/CT Imaging in Differentiating Oncocytic Tumors from Renal Cell Carcinoma in Routine Clinical Practice

Jared P. Schober, Avery Braun, Kevin B. Ginsburg, Spencer Bell, Alberto Andres Castro Bigalli, Michelle Chen, Robert Wang, Diana Magee, Laura Bukavina, Elizabeth Handorf, Jian Q. Yu, David Y.T. Chen, Richard E. Greenberg, Marc C. Smaldone, Rosalia Viterbo, Andres F. Correa, Robert G. Uzzo, Alexander Kutikov

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Purpose:Technetium-99m-sestamibi single-photon emission CT/x-ray CT is an emerging clinical tool to differentiate oncocytic tumors from renal cell carcinomas. We report data from a large institutional cohort of patients who underwent technetium-99m-sestamibi scans during evaluation of renal masses.Materials and Methods:Patients who underwent technetium-99m-sestamibi single-photon emission CT/x-ray CT between February 2020 and December 2021 were included in the analysis. Scans were defined as "hot" for oncocytic tumor when technetium-99m-sestamibi uptake was qualitatively equivalent or higher between the mass of interest and normal renal parenchyma, suggesting oncocytoma, hybrid oncocytic/chromophobe tumor, or chromophobe renal cell carcinoma. Demographic, pathological, and management strategy data were compared between "hot" and "cold" scans. For individuals who underwent diagnostic biopsy or extirpative procedures, the concordance between radiological findings and pathology was indexed.Results:A total of 71 patients (with 88 masses) underwent technetium-99m-sestamibi imaging with 60 (84.5%) patients having at least 1 "cold" mass on imaging and 11 (15.5%) patients exhibiting only "hot" masses. Pathology was available for 7 "hot" masses, with 1 biopsy specimen (14.3%) being discordant (clear cell renal cell carcinoma). Five patients with "cold" masses underwent biopsy. Out of 5 biopsied masses, 4 (80%) were discordant oncocytomas. Of the extirpated specimens, 35/40 (87.5%) harbored renal cell carcinoma and 5/40 (12.5%) yielded discordant oncocytomas. In sum, 20% of pathologically sampled masses that were "cold" on technetium-99m-sestamibi imaging still harbored oncocytoma/hybrid oncocytic/chromophobe tumor/chromophobe renal cell carcinoma.Conclusions:Further work is needed to define utility of technetium-99m-sestamibi in real-world clinical practice. Our data suggest this imaging strategy is not yet ready to replace biopsy.

Original languageEnglish
Pages (from-to)438-445
Number of pages7
JournalJournal of Urology
Volume210
Issue number3
DOIs
StatePublished - Sep 1 2023

Keywords

  • Adenoma, Oxyphilic/diagnostic imaging
  • Carcinoma, Renal Cell/diagnostic imaging
  • Humans
  • Kidney Neoplasms/diagnostic imaging
  • Radiopharmaceuticals
  • Single Photon Emission Computed Tomography Computed Tomography
  • Technetium Tc 99m Sestamibi
  • Tomography, Emission-Computed, Single-Photon/methods
  • Tomography, X-Ray Computed/methods

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