To determine the effectiveness of 99m Tc-sestamibi renal SPECT/CT in distinguishing between malignant and benign renal lesions.
Between June 2018 and October 2020 all patients with new indeterminate small renal masses (SRMs) underwent 99m Tc-sestamibi renal SPECT/CT prior to biopsy or surgery. The accuracy of 99m Tc-sestamibi imaging diagnoses was assessed against histopathology. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off for the tumour:normal uptake ratio. Logistic regression was used to determine if quantitative analysis significantly added to visual interpretation alone.
A total of 74 patients with SRMs were investigated with 99m Tc-sestamibi SPECT/CT. SPECT/CT correctly identified 49 malignant tumours and 11 benign tumours, resulting in a sensitivity of 0.89 [95% CI: 0.77 - 0.95] and a specificity of 0.73 [95% CI: 0.45 - 0.91]. ROC analysis of uptake ratios demonstrated that a tumour:normal uptake ratio of 0.41 provided optimal diagnostic accuracy (sensitivity 0.81, specificity 0.88, area under the curve 0.883 [95% CI:0.794 - 0.971]). The uptake ratio was also highly significant in excluding malignancy on univariate logistic regression analysis whereby the higher the uptake ratio, the lower the chances were for malignancy (OR 0.009,95% CI: 0.001-0.118, p < 0.001. However, this did not improve diagnostic accuracy when compared to visual interpretation alone.
99m Tc-sestamibi SPECT/CT is a non-invasive technique with good accuracy in determining if a SRM is benign or malignant.
BJU international. 2022 Apr 01 [Epub ahead of print]
Pravin Viswambaram, Alarick Picardo, Andrew Hohnen, Kevin Pham, William Macdonald, Dickon Hayne, Akhil Hamid
UWA Medical School, University of Western Australia, Crawley, WA, Australia., Fiona Stanley Hospital, Murdoch, WA, Australia., Liverpool Hospital, Sydney, NSW, Australia.