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Review
. 2024 Jun 21;5(7):636-650.
doi: 10.1002/bco2.355. eCollection 2024 Jul.

Imaging modalities for characterising T1 renal tumours: A systematic review and meta-analysis of diagnostic accuracy

Hannah Warren  1   2 , Jack B Fanshawe  3 , Valerie Mok  4 , Priyanka Iyer  5 , Vinson Wai-Shun Chan  6 , Richard Hesketh  7 , Eleanor Zimmermann  8 , Veeru Kasivisvanathan  1 , Mark Emberton  1 , Maxine G B Tran  1   2 , Kurinchi Gurusamy  1
Affiliations
Review

Imaging modalities for characterising T1 renal tumours: A systematic review and meta-analysis of diagnostic accuracy

Hannah Warren et al. BJUI Compass. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] BJUI Compass. 2024 Dec 30;5(12):1324-1329. doi: 10.1002/bco2.482. eCollection 2024 Dec. BJUI Compass. 2024. PMID: 39744071 Free PMC article.

Abstract

Objectives: International guidelines recommend resection of suspected localised renal cell carcinoma (RCC), with surgical series showing benign pathology in 30%. Non-invasive diagnostic tests to differentiate benign from malignant tumours are an unmet need. Our objective was to determine diagnostic accuracy of imaging modalities for detecting cancer in T1 renal tumours.

Methods: A systematic review was performed for reports of diagnostic accuracy of any imaging test compared to a reference standard of histopathology for T1 renal masses, from inception until January 2023. Twenty-seven publications (including 2277 tumours in 2044 participants) were included in the systematic review, and nine in the meta-analysis.

Results: Forest plots of sensitivity and specificity were produced for CT (seven records, 1118 participants), contrast-enhanced ultrasound (seven records, 197 participants), [99mTc]Tc-sestamibi SPECT/CT (five records, 263 participants), MRI (three records, 220 participants), [18F]FDG PET (four records, 43 participants), [68Ga]Ga-PSMA-11 PET (one record, 27 participants) and [111In]In-girentuximab SPECT/CT (one record, eight participants). Meta-analysis returned summary estimates of sensitivity and specificity for [99mTc]Tc-sestamibi SPECT/CT of 88.6% (95% CI 82.7%-92.6%) and 77.0% (95% CI 63.0%-86.9%) and for [18F]FDG PET 53.5% (95% CI 1.6%-98.8%) and 62.5% (95% CI 14.0%-94.5%), respectively. A comparison hierarchical summary receiver operating characteristic (HSROC) model did not converge. Meta-analysis was not performed for other imaging due to different thresholds for test positivity.

Conclusion: The optimal imaging strategy for T1 renal masses is not clear. [99mTc]Tc-sestamibi SPECT/CT is an emerging tool, but further studies are required to inform its role in clinical practice. The field would benefit from standardisation of diagnostic thresholds for CT, MRI and contrast-enhanced ultrasound to facilitate future meta-analyses.

Keywords: diagnostic accuracy; imaging; renal tumours.

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Conflict of interest statement

HW receives salary support from The Urology Foundation, Pan London Cancer Alliance (Royal Marsden Partners, North Central London Cancer Alliance, North East London Cancer Alliance, South East London Cancer Alliance and the NIHR BRCs) and the Wellcome/EPSRC Centre for Interventional and Surgical Sciences. The promotions and salaries of KG are dependent upon the publishing of research protocols and findings. Other authors have no relevant interests to declare.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram showing study selection process and reasons for exclusion from the meta‐analysis.
FIGURE 2
FIGURE 2
Risk of bias and applicability concerns summary: review authors' judgement about each domain for each included study.
FIGURE 3
FIGURE 3
Forest plot of estimates of sensitivity and specificity of (A) contrast‐enhanced computed tomography, (B) contrast‐enhanced ultrasound, (C) [99mTc]Tc‐sestamibi SPECT/CT, (D) [18F]FDG PE, (E) multiparametric magnetic resonance imaging, (F) [68Ga]Ga‐PSMA‐11 PET and (G) [111In]In‐girentuximab SPECT/CT for the diagnosis of tumour malignancy. CI, confidence interval; FN, false negatives; FP, false positives; TN, true negatives; TP, true positives.
FIGURE 4
FIGURE 4
Summary receiver operating characteristic curve of five included studies reporting the diagnostic accuracy of [99mTc]Tc‐sestamibi SPECT/CT to detect malignancy in patients presenting with T1 renal tumours. ○ = estimate from individual study ● = summary estimate = 95% confidence region. Summary estimates of sensitivity and specificity to detect cancer are 88.6% (95% CI 82.7%–92.6%) and 77.0% (95% CI 63.0%–86.9%), respectively.
FIGURE 5
FIGURE 5
Summary receiver operating characteristic curve of four included studies reporting the diagnostic accuracy of [18F]FDG PET to detect malignancy in patients presenting with T1 renal tumours. ○ = estimate from individual study ● = summary estimate = 95% confidence region. Summary estimates of sensitivity and specificity for [18F]FDG PET to detect cancer are 53.5% (95% CI 1.6%–98.8%) and 62.5% (95% CI 14.0%–94.5%), respectively.
See this image and copyright information in PMC

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