Imaging of Chromophobe Renal Cell Carcinoma with ^99mTc-Sestamibi SPECT/CT: Considerations Regarding Risk Stratification and Histologic Reclassification.

IF 3 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Molecular Imaging and Biology Pub Date : 2024-10-01 Epub Date: 2024-07-29 DOI:10.1007/s11307-024-01938-6

Steven P Rowe, Salikh Murtazaliev, Jorge D Oldan, Basil Kaufmann, Amna Khan, Mohammad E Allaf, Nirmish Singla, Christian P Pavlovich, Angelo M De Marzo, Ezra Baraban, Michael A Gorin, Lilja B Solnes

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Abstract

Purpose: Indeterminate renal masses are increasingly incidentally found on cross-sectional imaging. ^99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) scans can be used to identify oncocytomas and oncocytic renal neoplasms, including a subset of chromophobe renal cell carcinomas (chRCCs), which are viewed as false-positive.

Procedure: Patients imaged with renal sestamibi scans between 2014 and 2023 were reviewed. Those patients with solitary tumors that were originally classified as chRCC were included in the analysis. Imaging with SPECT/CT from the liver dome down had been carried out 75 min after the administration of 925 MBq of ^99mTc-sestamibi. All available H&E and immunostained slides were re-reviewed and classified according to WHO 2022 criteria. Confirmatory immunohistochemical stains were performed in tumors considered morphologically suspicious for non-chRCC entities.

Result: A total of 18 patients with solitary tumors were included in the final analysis. 13/18 (72.2%) tumors in this cohort remained classified as chRCC, with 4/18 (22.2%) being eosinophilic-variant chRCC. The reclassified tumors (5/18 [27.8%]) included 2/18 (11.1%) low-grade oncocytic tumor (LOT), 1/18 (5.5%) eosinophilic vacuolated tumor (EVT), and 2/18 (11.1%) unclassified low-grade oncocytic neoplasms. As such, only 2/9 (22.2%) qualitatively "hot" tumors were chRCC other than eosinophilic-variant and only 1/9 (11.1%) "cold" tumors was a histology other than chRCC.

Conclusion: Based on current histopathologic classification methods, it is likely that the "false-positive" rate of uptake on renal sestamibi scans with chRCC has been over-stated. Further study is warranted to better refine the optimal utility of renal sestamibi scans for non-invasive risk stratification of indeterminate renal masses.

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利用 99mTc-Sestamibi SPECT/CT 对嗜铬肾细胞癌进行成像：有关风险分层和组织学重新分类的考虑。

目的：在横断面成像中偶然发现的不确定肾肿块越来越多。99m锝-铯同位素单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）扫描可用于识别肿瘤细胞瘤和肿瘤细胞性肾肿瘤，包括被视为假阳性的嗜铬肾细胞癌（chRCC）亚群：对2014年至2023年期间接受肾脏塞他嘧啶扫描的患者进行回顾性研究。那些最初被归类为chRCC的单发肿瘤患者被纳入分析范围。在施用 925 MBq 的 99mTc-sestamibi 75 分钟后，从肝脏穹顶向下进行 SPECT/CT 成像。对所有可用的 H&E 和免疫染色切片进行了重新审查，并根据 WHO 2022 标准进行了分类。对形态学上怀疑为非红斑狼疮实体的肿瘤进行免疫组化染色确认：结果：共有 18 例单发肿瘤患者纳入最终分析。其中13/18（72.2%）的肿瘤仍被归类为chRCC，4/18（22.2%）为嗜酸性变异型chRCC。重新分类的肿瘤（5/18 [27.8%]）包括2/18（11.1%）低级别肿瘤（LOT）、1/18（5.5%）嗜酸性空泡瘤（EVT）和2/18（11.1%）未分类的低级别肿瘤。因此，只有2/9（22.2%）定性为 "热 "的肿瘤是嗜酸性空泡变异型以外的ChRCC，只有1/9（11.1%）定性为 "冷 "的肿瘤是ChRCC以外的组织学类型：结论：根据目前的组织病理学分类方法，chRCC 的肾脏塞他嘧啶扫描摄取 "假阳性 "率可能被夸大了。我们需要进一步研究，以更好地完善肾脏咝声嘧啶扫描在对不确定的肾脏肿块进行非侵入性风险分层时的最佳效用。

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来源期刊

Molecular Imaging and Biology 医学-核医学

CiteScore

6.90

自引率

3.20%

发文量

审稿时长

3 months

期刊介绍： Molecular Imaging and Biology (MIB) invites original contributions (research articles, review articles, commentaries, etc.) on the utilization of molecular imaging (i.e., nuclear imaging, optical imaging, autoradiography and pathology, MRI, MPI, ultrasound imaging, radiomics/genomics etc.) to investigate questions related to biology and health. The objective of MIB is to provide a forum to the discovery of molecular mechanisms of disease through the use of imaging techniques. We aim to investigate the biological nature of disease in patients and establish new molecular imaging diagnostic and therapy procedures. Some areas that are covered are: Preclinical and clinical imaging of macromolecular targets (e.g., genes, receptors, enzymes) involved in significant biological processes. The design, characterization, and study of new molecular imaging probes and contrast agents for the functional interrogation of macromolecular targets. Development and evaluation of imaging systems including instrumentation, image reconstruction algorithms, image analysis, and display. Development of molecular assay approaches leading to quantification of the biological information obtained in molecular imaging. Study of in vivo animal models of disease for the development of new molecular diagnostics and therapeutics. Extension of in vitro and in vivo discoveries using disease models, into well designed clinical research investigations. Clinical molecular imaging involving clinical investigations, clinical trials and medical management or cost-effectiveness studies.