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.

[1]  M. Rubin,et al.  The 2022 World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. , 2022, European urology.

[2]  P. Katlariwala,et al.  A review of 99mTc-sestamibi SPECT/CT for renal oncocytomas: A modified diagnostic algorithm. , 2022, Intractable & rare diseases research.

[3]  K. Trpkov,et al.  Do we need an updated classification of oncocytic renal tumors? , 2022, Modern Pathology.

[4]  K. Trpkov,et al.  Low-grade oncocytic tumor (LOT) - a new renal entity ready for a prime time: An updated review. , 2022, Histology and Histopathology.

[5]  Sourav K. Mishra,et al.  Oncocytic renal neoplasms with diffuse keratin 7 immunohistochemistry harbor frequent alterations in the mammalian target of rapamycin pathway , 2021, Modern Pathology.

[6]  I. Pedrosa,et al.  Germline and sporadic mTOR pathway mutations in low-grade oncocytic tumor of the kidney , 2021, Modern Pathology.

[7]  M. Sibony,et al.  Low-grade oncocytic renal tumor (LOT): mutations in mTOR pathway genes and low expression of FOXI1 , 2021, Modern Pathology.

[8]  Liang Cheng,et al.  Low-grade oncocytic tumour expands the spectrum of renal oncocytic tumours and deserves separate classification: a review of 23 cases from a single tertiary institute , 2021, Journal of Clinical Pathology.

[9]  J. Cheville,et al.  Low-Grade Oncocytic Tumor of Kidney (CK7-Positive, CD117-Negative): Incidence in a Single Institutional Experience with Clinicopathological and Molecular Characteristics. , 2021, Human pathology.

[10]  S. Sheikhbahaei,et al.  When more is better: Underused advanced imaging exams that can improve outcomes and reduce cost of care. , 2021, The American journal of medicine.

[11]  T. Tsuzuki,et al.  A Case of Low-Grade Oncocytic Tumor/Chromophobe Renal Cell Carcinoma (Oncocytic Variant) of the Kidney , 2021, Case reports in pathology.

[12]  A. Morshid,et al.  A Concise Review of the Multimodality Imaging Features of Renal Cell Carcinoma , 2021, Cureus.

[13]  J. Cheville,et al.  Novel, emerging and provisional renal entities: The Genitourinary Pathology Society (GUPS) update on renal neoplasia , 2021, Modern Pathology.

[14]  A. Feuchtinger,et al.  In Situ Metabolomics Expands the Spectrum of Renal Tumours Positive on 99mTc-sestamibi Single Photon Emission Computed Tomography/Computed Tomography Examination , 2020, European urology open science.

[15]  Patrick D. McGillivray,et al.  Distinguishing Benign Renal Tumors with an Oncocytic Gene Expression (ONEX) Classifier. , 2020, European urology.

[16]  E. Compérat,et al.  Renal Oncocytoma: an algorithm for diagnosis and management. , 2020, Urology.

[17]  S. Dhanasekaran,et al.  Next-generation RNA Sequencing-based Biomarker Characterization of Chromophobe Renal Cell Carcinoma and Related Oncocytic Neoplasms. , 2020, European urology.

[18]  M. Murad,et al.  Diagnostic accuracy of 99mTc-sestamibi SPECT/CT for detecting renal oncocytomas and other benign renal lesions: a systematic review and meta-analysis , 2020, Abdominal Radiology.

[19]  C. Park,et al.  Comprehensive Immunoprofiles of Renal Cell Carcinoma Subtypes , 2020, Cancers.

[20]  M. Javadi,et al.  Cost-effectiveness Analysis of 99mTc-sestamibi SPECT/CT to Guide Management of Small Renal Masses. , 2020, European urology focus.

[21]  M. Karlsson,et al.  Intra- and Interobserver Agreement of SUV SPECT Quantitative SPECT/CT Processing Software, Applied in Clinical Settings for Patients with Solid Renal Tumors , 2019, The Journal of Nuclear Medicine Technology.

[22]  Daniel S. Atherton,et al.  Hybrid oncocytic/chromophobe renal tumors are molecularly distinct from oncocytoma and chromophobe renal cell carcinoma , 2019, Modern Pathology.

[23]  A. Sangoi,et al.  Low‐grade oncocytic tumour of kidney (CD117‐negative, cytokeratin 7‐positive): a distinct entity? , 2019, Histopathology.

[24]  Huadan Xue,et al.  Can quantitative CT texture analysis be used to differentiate subtypes of renal cell carcinoma? , 2019, Clinical radiology.

[25]  John Dickson,et al.  Quantitative SPECT: the time is now , 2019, EJNMMI Physics.

[26]  M. Tretiakova,et al.  Clinical Utility of Chromosome Genomic Array Testing for Unclassified and Advanced-Stage Renal Cell Carcinomas. , 2018, Archives of pathology & laboratory medicine.

[27]  B. Chung,et al.  Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014 , 2019, JAMA surgery.

[28]  R. Uzzo,et al.  Active Surveillance for Localized Renal Masses: Tumor Growth, Delayed Intervention Rates, and >5-yr Clinical Outcomes. , 2018, European urology.

[29]  Jurgen J. Fütterer,et al.  Diagnostic Imaging for Solid Renal Tumors: A Pictorial Review , 2018, Kidney cancer.

[30]  F. Montorsi,et al.  Variants and Variations in Epithelial Renal Cell Tumors in Adults: The Pathologist's Point of View , 2017 .

[31]  P. Pierorazio,et al.  Surgical histopathology for suspected oncocytoma on renal mass biopsy: a systematic review and meta‐analysis , 2017, BJU international.

[32]  M. Karlsson,et al.  Visual evaluation and differentiation of renal oncocytomas from renal cell carcinomas by means of 99mTc-sestamibi SPECT/CT , 2017, EJNMMI Research.

[33]  A. Evans,et al.  Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[34]  R. Mehra,et al.  Morphologic, Molecular, and Taxonomic Evolution of Renal Cell Carcinoma: A Conceptual Perspective With Emphasis on Updates to the 2016 World Health Organization Classification. , 2016, Archives of pathology & laboratory medicine.

[35]  Hui Liu,et al.  Noise suppressed partial volume correction for cardiac SPECT/CT. , 2016, Medical physics.

[36]  P. Humphrey,et al.  The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile, and Testicular Tumours. , 2016, European urology.

[37]  Mark W. Ball,et al.  Prospective Evaluation of (99m)Tc-sestamibi SPECT/CT for the Diagnosis of Renal Oncocytomas and Hybrid Oncocytic/Chromophobe Tumors. , 2016, European urology.

[38]  R. Langer,et al.  High‐resolution MALDI‐FT‐ICR MS imaging for the analysis of metabolites from formalin‐fixed, paraffin‐embedded clinical tissue samples , 2015, The Journal of pathology.

[39]  A. Feuchtinger,et al.  Supremacy of modern morphometry in typing renal oncocytoma and malignant look-alikes , 2015, Histochemistry and Cell Biology.

[40]  Mark W. Ball,et al.  Initial Experience Using 99mTc-MIBI SPECT/CT for the Differentiation of Oncocytoma From Renal Cell Carcinoma , 2015, Clinical nuclear medicine.

[41]  P. Camparo,et al.  Hybrid oncocytic/chromophobe renal cell tumours do not display genomic features of chromophobe renal cell carcinomas , 2013, Virchows Archiv.