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

No AccessJournal of UrologyAdult Urology28 Jun 2023Clinical Performance of Technetium-99m–Sestamibi SPECT/CT Imaging in Differentiating Oncocytic Tumors from Renal Cell Carcinoma in Routine Clinical PracticeThis article is commented on by the following:Editorial Comment 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, and Alexander Kutikov Jared P. SchoberJared P. Schober *Correspondence: Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA 19111 telephone: 509-540-9403; E-mail Address: [email protected] Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Avery BraunAvery Braun Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Kevin B. GinsburgKevin B. Ginsburg Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Spencer BellSpencer Bell Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Alberto Andres Castro BigalliAlberto Andres Castro Bigalli Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Michelle ChenMichelle Chen Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Robert WangRobert Wang Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Diana MageeDiana Magee Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Laura BukavinaLaura Bukavina Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Elizabeth HandorfElizabeth Handorf Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Jian Q. YuJian Q. Yu Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania , David Y. T. ChenDavid Y. T. Chen Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Richard E. GreenbergRichard E. Greenberg Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Marc C. SmaldoneMarc C. Smaldone Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Rosalia ViterboRosalia Viterbo Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Andres F. CorreaAndres F. Correa Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , Robert G. UzzoRobert G. Uzzo Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania , and Alexander KutikovAlexander Kutikov Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania View All Author Informationhttps://doi.org/10.1097/JU.0000000000003557AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail 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. REFERENCES 1. . Small renal mass. N Engl J Med.2010; 362(7):624-634. Crossref, Medline, Google Scholar 2. . The incidental renal mass- update on characterization and management. Radiol Clin North Am.2021; 59(4):631-646. Crossref, Medline, Google Scholar 3. No difference in renal function outcomes for patients with oncocytoma managed with active surveillance vs. partial nephrectomy. Urol Oncol. 2023; 41(3):149.e11-149.e16. Crossref, Medline, Google Scholar 4. . 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Ethics Statement: This study received Institutional Review Board approval (IRB No. 21-9054). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology28 Jun 2023Editorial Comment Supplementary Materials Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsbiopsyoncocytomawatchful waitingrenalradionuclide imagingkidney neoplasmsACKNOWLEDGMENTSWe thank Irena Osipchyk (CorelDrawX8) for postanalysis figure editing.MetricsAuthor Information Jared P. Schober Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania *Correspondence: Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA 19111 telephone: 509-540-9403; E-mail Address: [email protected] More articles by this author Avery Braun Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Kevin B. Ginsburg Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Spencer Bell Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Alberto Andres Castro Bigalli Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Michelle Chen Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Robert Wang Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Diana Magee Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Laura Bukavina Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Elizabeth Handorf Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Jian Q. Yu Department of Diagnostic Imaging, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author David Y. T. Chen Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Richard E. Greenberg Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Marc C. Smaldone Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Rosalia Viterbo Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Andres F. Correa Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Robert G. Uzzo Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Alexander Kutikov Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania More articles by this author Expand All Submitted November 11, 2022; accepted May 11, 2023; published 000. Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 21-9054). Advertisement PDF downloadLoading ...