^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, SUV_max 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.

Keywords:

• 99mTc Sestamibi SPECT/CT
• renal oncocytoma
• renal cell carcinoma
• hybrid imaging

Disclosure statement

The authors declare no competing interests.

Authors contributions

AT, RA initiated and designed the study. AT, TP, OG, SG, KT, LE-E, AA, MH, MK, RA evaluated data. AT, AA, GK organised data. AT wrote the first draft, and all authors revised the manuscript critically.

Email addresses to co-authors:

Thomas Papathomas: [email protected]

Ove Gustafsson: [email protected]

Stefan Gabrielson: [email protected]

Linnea Ekström-Ehn: [email protected]

Kiril Trpkov: [email protected]

Alexandros Arvanitis: [email protected]

Maria Holstensson: [email protected]

Mattias Karlsson: [email protected]

Georgia Kokaraki: [email protected]

Rimma Axelsson: [email protected]

Additional information

Funding

This study was financially supported by Sweden’s innovation agency VINNOVA as part of the Molecular Imaging for Differentiation of Oncocytomas from Renal cancer (MIDOR) study (Reference nr. 2015-0180). Hermes Medical Solutions AB Stockholm, Sweden, provided the software used for the evaluation of SPECT/CT images.