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  • Review Article
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Nuclear imaging of renal tumours: a step towards improved risk stratification

Nature Reviews Urology volume 12, pages 445–450 (2015)Cite this article

Subjects

Key Points

  • The indeterminate renal mass is a diverse clinical entity which includes both benign and malignant tumour types

  • Accurate knowledge of tumour histology is required for a risk-adapted approach to patient care; for example, benign or indolent renal tumours can be observed and more aggressive tumours treated surgically

  • Anatomical imaging techniques, including CT, MRI and ultrasonography, are unable to reliably distinguish between the various types of renal tumours

  • Renal mass biopsy is infrequently performed owing to a high nondiagnostic rate and risk of complications; a number of nuclear imaging tests have been explored as an alternative

  • One of the most promising of these tests is 124I-girentuximab PET/CT, which was shown in a large prospective study to accurately distinguish clear cell renal cell carcinoma from other tumour histologies

  • Additional work is needed to better define the relative strengths and limitations of the various nuclear imaging tests before they can be fully incorporated into clinical practice

Abstract

Patients presenting with a clinically localized renal mass should ideally be managed with a risk-adapted approach that incorporates data regarding the metastatic potential of a given tumour. Unfortunately, currently available anatomical imaging techniques are unable to reliably distinguish between the various types of renal tumours, which include both benign and malignant histologies. Nuclear imaging offers a potential noninvasive means to characterize clinically localized renal tumours. A number of nuclear imaging tests are currently under investigation for this purpose and might one day be incorporated into patient care.

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Figure 1
Figure 2
Figure 3: Representative images of a pathologically proven oncocytoma and ccRCC acquired with standard cross-sectional imaging and 99mTc-sestamibi SPECT/CT.
Figure 4: Proposed algorithm incorporating nuclear imaging data for the management of patients presenting with an indeterminate cT1 renal mass.

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Author information

Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, 21287, MD, USA

    Michael A. Gorin & Mohamad E. Allaf

  2. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Room 4210, Baltimore, 21287, MD, USA

    Steven P. Rowe

Authors
  1. Michael A. Gorin
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  3. Mohamad E. Allaf
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Contributions

M.A.G. researched data for the article. M.A.G. and S.P.R. wrote the manuscript. All authors made substantial contributions to discussions of content and reviewed and edited the article before submission.

Corresponding author

Correspondence to Michael A. Gorin.

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Competing interests

The authors have filed a provisional application for a patent regarding the use of 99mTc-sestamibi for the imaging of renal tumours.

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Gorin, M., Rowe, S. & Allaf, M. Nuclear imaging of renal tumours: a step towards improved risk stratification. Nat Rev Urol 12, 445–450 (2015). https://doi.org/10.1038/nrurol.2015.122

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