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.
Highlights
Despite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion
Approximately 1000 renal tumours are newly diagnosed in Sweden annually [1, 2] with 120 patients out of 250 patients within the Stockholm County being treated at Karolinska University Hospital for suspected renal cell carcinoma (RCC)
Any focal 99mTc-sestamibi uptake detected on SPECT in the localisation of known tumour detected on CT was regarded as 99mTc-sestamibi positive, whereas lesions with 99mTc-sestamibi uptake lower than normal renal parenchyma were considered to be 99mTcsestamibi negative
Summary
Despite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion. 10% of all solid renal tumours turn out to be oncocytomas. 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. Any focal 99mTc-sestamibi uptake detected on SPECT in the localisation of tumour was considered as positive. 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. 1000 renal tumours are newly diagnosed in Sweden annually [1, 2] with 120 patients out of 250 patients within the Stockholm County being treated at Karolinska University Hospital for suspected renal cell carcinoma (RCC). Renal oncocytomas can be multiple in 6% and bilateral in 5% and can develop metachronic tumours in 4% of the cases [15]
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