背景:在肾脏肿块不确定的情况下,当前成像技术在区分良性和恶性肿瘤方面的诊断准确性仍然欠佳。
目的:评估99mTc-sestamibi(SestaMIBI)单光子发射断层扫描计算机断层扫描(SPECT)/CT在通过区分肾嗜酸细胞瘤和杂合嗜酸细胞/发色细胞瘤(HOCT)与(1)所有其他肾脏病变和(2)所有恶性肾脏病变来表征不确定肾脏肿块的诊断准确性。次要结果是:(1)良性与恶性;(2)肾嗜酸细胞瘤和HOCT与透明细胞(ccRCC)和乳头状(pRCC)肾细胞癌;(3)肾嗜酸细胞瘤和HOCT与嫌色细胞肾细胞癌(chRCC)。
方法:截至2022年11月,使用PubMed/MEDLINE进行了文献检索,Embase,和WebofScience数据库。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目,以确定合格的研究。研究包括前瞻性和回顾性横断面研究,其中将SestaMIBISPECT/CT结果与肾脏肿块活检或手术后的组织学进行了比较。
结果:总体而言,包括489例患者和501例肾脏肿块的8项研究符合我们的纳入标准.SestaMIBISPECT/CT对肾嗜酸细胞瘤和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%CI86-92%),分别。值得注意的是,对于肾嗜酸细胞瘤和HOCT与ccRCC和pRCC,SestaMIBISPECT/CT的特异性为98%(95%CI91-100%),敏感性相似。由于偏倚的风险相对较高,并且在纳入的研究中存在异质性,证据水平仍然很低。
结论:SestaMIBISPECT/CT在区分肾嗜酸细胞瘤和HOCT与所有其他肾脏病变方面具有良好的敏感性和特异性,特别是那些肿瘤行为更具攻击性的人。虽然这些结果很有希望,需要进一步的研究来支持在研究试验之外使用SestaMIBISPECT/CT.
结果:一种称为SestaMIBISPECT/CT的扫描方法有望诊断肾脏肿瘤是否恶性。然而,由于我们综述的证据水平较低,因此它仍应限于研究试验.
The diagnostic accuracy of current imaging techniques in differentiating benign from malignant neoplasms in the case of indeterminate renal masses is still suboptimal.
To evaluate the diagnostic accuracy of 99mTc-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).
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.
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.
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.
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.