Abstract
The purpose of this study was to assess the efficiency of fluorine-18 fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in the characterisation and primary staging of suspicious renal masses, in comparison with computed tomography, the current standard imaging modality. Fifty-three FDG PET studies were performed within the framework of a prospective study: 35 for both characterisation and staging of a suspicious mass, and 18 for staging early after surgical removal of a renal cancer. In the characterisation of renal masses, a high rate of false negative results was observed, leading to a sensitivity, specificity and accuracy of 47%, 80% and 51% respectively, versus 97%, 0/5 and 83% respectively for CT. FDG PET detected all the sites of distant metastasis revealed by CT, as well as eight additional metastatic sites, leading to an accuracy of 94% versus 89% for CT. However, 36/53 patients (68%) did not have any distant metastasis on either CT or on PET. All but one of these patients had a low Fuhrman histological grade and a limited local stage (≤pT2). We conclude that FDG PET does not offer any advantage over CT for the characterisation of renal masses but that it appears to be an efficient tool for the detection of distant metastasis in renal cancer. However, our data suggest that a selection process could be implemented to determine which patients should undergo PET. FDG PET could be performed in the event of a solitary metastasis or doubtful images on CT. Selection could also be based on adverse histological findings from nephrectomy specimens in order to perform staging early after nephrectomy.
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Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncol 2001; 2:157–164.
Wahl RL, Harney J, Hutchins G, Grossman HB. Imaging of renal cancer using positron emission tomography with 2-deoxy-2-(18F)-fluoro-d-glucose: pilot animal and human studies. J Urol 1991; 146:1470–1474.
Kocher F, Geimmel S, Hauptmann R, Reske S. Preoperative lymph node staging in patients with kidney and urinary bladder neoplasm. J Nucl Med 1994; 35:223P.
Bachor R, Kotzerke J, Gottfried HW, Brandle E, Reske SN, Hautmann R. Positron emission tomography in diagnosis of renal cell carcinoma. Urologe A 1996; 35:146–150.
Goldberg MA, Mayo-Smith WW, Papanicolaou N, Fischman AJ, Lee MJ. FDG PET characterization of renal masses: preliminary experience. Clin Radiol 1997; 52:510–515.
Montravers F, Grahek D, Kerrou K, et al. Evaluation of FDG uptake by renal malignancies (primary tumor or metastases) using a coincidence detection gamma camera. J Nucl Med 2000; 41:78–84.
Ramdave S, Thomas GW, Berlangieri SU, Bolton DM, Davis I, Danguy HT. Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma. J Urol 2001; 166:825–830.
Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, "Onko-PET III", 21 July and 19 September 2000. Eur J Nucl Med 2001; 28:1707–1723.
Agostini D, Bensadoun H, Rabut B, Bottet P, Aide N, Derlon JM. New 3D whole body PET imaging to detect metastatic renal cancer with18F-FDG. J Nucl Med 2001; 42:288P.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982; 6:655–663.
Amendola MA, Bree RL, Pollack HM, et al. Small renal cell carcinomas: resolving a diagnostic dilemma. Radiology 1988; 166:637–641.
Miyauchi T, Brown RS, Grossman HB, Wojno K, Wahl RL. Correlation between visualization of primary renal cancer by FDG-PET and histopathological findings. J Nucl Med 1996; 37:64P.
Miyakita H, Tokunaga M, Onda H, Usui Y, Kinoshita H, Kawamura N, et al. Significance of18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of renal cell carcinoma and immunohistochemical glucose transporter 1 (GLUT-1) expression in the cancer. Int J Urol 2002; 9:15–18.
Montravers F, Rousseau C, Doublet JD, et al. In vivo inaccessibility of somatostatin receptors to111In-pentreotide in primary renal cell carcinoma. Nucl Med Commun 1998; 19:953–961.
Boerner AR, Weckesser M, Herzog H, et al. Optimal scan time for fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer. Eur J Nucl Med 1999; 26:226–230.
Mickisch G, Carballido J, Hellsten S, Schulze H, Mensink H. Guidelines on renal cell cancer. Eur Urol 2001; 40:252–255.
Fujimoto N, Sugita A, Terasawa Y, Kato M. Observations on the growth rate of renal cell carcinoma. Int J Urol 1995; 2:71–76.
Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 2001; 345:1655–1659.
Ficarro V, Righetti R, Pilloni S, et al. Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol 2002; 41:190–198.
Minervini A, Lilas L, Minervini R, Selli C. Prognostic value of nuclear grading in patients with intracapsular (pT1–pT2) renal cell carcinoma. Long-term analysis in 213 patients. Cancer 2002; 94:2590–2595.
Acknowledgements
The authors wish to thank Dr. Montravers and Prof. Talbot, from the Department of Nuclear Medicine and PET Centre of Tenon Hospital, Paris, for their help and interesting remarks. The technical staff of Cyceron PET Centre are thanked for patient management and image acquisition.
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Aide, N., Cappele, O., Bottet, P. et al. Efficiency of [18F]FDG PET in characterising renal cancer and detecting distant metastases: a comparison with CT. Eur J Nucl Med Mol Imaging 30, 1236–1245 (2003). https://doi.org/10.1007/s00259-003-1211-4
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DOI: https://doi.org/10.1007/s00259-003-1211-4