Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Department of Urology, IRCCS European Institute of Oncology, IEO, Milan, Italy.
Eur Urol. 2024 Jan;85(1):63-71. doi: 10.1016/j.eururo.2023.07.013. Epub 2023 Sep 5.
CONTEXT: The diagnostic accuracy of current imaging techniques in differentiating benign from malignant neoplasms in the case of indeterminate renal masses is still suboptimal. OBJECTIVE: To evaluate the diagnostic accuracy of Tc-sestamibi (SestaMIBI) single-photon emission tomography computed tomography (SPECT)/CT in characterizing indeterminate renal masses by differentiating renal oncocytoma and hybrid oncocytic/chromophobe tumor (HOCT) from (1) all other renal lesions and (2) all malignant renal lesions. Secondary outcomes were: (1) benign versus malignant; (2) renal oncocytoma and HOCT versus clear cell (ccRCC) and papillary (pRCC) renal cell carcinoma; and (3) renal oncocytoma and HOCT versus chromophobe renal cell carcinoma (chRCC). EVIDENCE ACQUISITION: A literature search was conducted up to November 2022 using the PubMed/MEDLINE, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify eligible studies. Studies included were prospective and retrospective cross-sectional studies in which SestaMIBI SPECT/CT findings were compared to histology after renal mass biopsy or surgery. EVIDENCE SYNTHESIS: Overall, eight studies involving 489 patients with 501 renal masses met our inclusion criteria. The sensitivity and specificity of SestaMIBI SPECT/CT for renal oncocytoma and HOCT versus all other renal lesions were 89% (95% confidence interval [CI] 70-97%) and 89% (95% CI 86-92%), respectively. Notably, for renal oncocytoma and HOCT versus ccRCC and pRCC, SestaMIBI SPECT/CT showed specificity of 98% (95% CI 91-100%) and similar sensitivity. Owing to the relatively high risk of bias and the presence of heterogeneity among the studies included, the level of evidence is still low. CONCLUSIONS: SestaMIBI SPECT/CT has good sensitivity and specificity in differentiating renal oncocytoma and HOCT from all other renal lesions, and in particular from those with more aggressive oncological behavior. Although these results are promising, further studies are needed to support the use of SestaMIBI SPECT/CT outside research trials. PATIENT SUMMARY: A scan method called SestaMIBI SPECT/CT has promise for diagnosing whether kidney tumors are malignant or not. However, it should still be limited to research trials because the level of evidence from our review is low.
背景：目前，在鉴别不确定肾脏肿块的良恶性方面，各种影像学技术的诊断准确性仍然不够理想。
目的：通过鉴别肾脏嗜酸细胞瘤和混合嗜酸/嫌色细胞瘤（HOCT）与（1）所有其他肾脏病变，以及（2）所有恶性肾脏病变，评估 Tc-sestamibi（SestaMIBI）单光子发射计算机断层扫描（SPECT）/CT 在描述不确定肾脏肿块方面的诊断准确性。次要结局为：（1）良性与恶性；（2）肾脏嗜酸细胞瘤和 HOCT 与透明细胞（ccRCC）和乳头状（pRCC）肾细胞癌；以及（3）肾脏嗜酸细胞瘤和 HOCT 与嫌色细胞肾细胞癌（chRCC）。
证据获取：截至 2022 年 11 月，我们使用 PubMed/MEDLINE、Embase 和 Web of Science 数据库进行了文献检索。我们遵循了系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南，以确定符合条件的研究。纳入的研究为前瞻性和回顾性的横断面研究，其中 SestaMIBI SPECT/CT 结果与肾脏肿块活检或手术后的组织学进行了比较。
证据综合：共有八项研究纳入了 489 名患者的 501 个肾脏肿块，符合我们的纳入标准。SestaMIBI SPECT/CT 对肾脏嗜酸细胞瘤和 HOCT 与所有其他肾脏病变的敏感性和特异性分别为 89%（95%置信区间 [CI] 70-97%）和 89%（95% CI 86-92%）。值得注意的是，对于肾脏嗜酸细胞瘤和 HOCT 与 ccRCC 和 pRCC，SestaMIBI SPECT/CT 的特异性为 98%（95% CI 91-100%），敏感性相似。由于纳入的研究存在较高的偏倚风险和异质性，因此证据水平仍然较低。
结论：SestaMIBI SPECT/CT 在鉴别肾脏嗜酸细胞瘤和 HOCT 与所有其他肾脏病变，特别是与具有更具侵袭性的肿瘤行为的病变方面具有良好的敏感性和特异性。尽管这些结果很有前景，但仍需要进一步的研究来支持 SestaMIBI SPECT/CT 在研究试验之外的应用。
患者总结：一种名为 SestaMIBI SPECT/CT 的扫描方法有望用于诊断肾脏肿瘤是否为恶性。然而，由于我们的综述证据水平较低，它仍应仅限于研究试验。
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