Efficacy of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography for detecting renal cell carcinoma in patients with end-stage renal disease

Hiromi Hirasawa; Ayako Taketomi-Takahashi; Natsumi Katsumata; Tetsuya Higuchi; Yoshitaka Sekine; Kazuhiro Suzuki; Yoriaki Kaneko; Keiju Hiromura; Yasuhiro Fukushima; Yoshito Tsushima

doi:10.1007/s11604-024-01593-5

Efficacy of ¹⁸F-Fluorodeoxyglucose positron emission tomography/computed tomography for detecting renal cell carcinoma in patients with end-stage renal disease

Jpn J Radiol. 2024 May 25. doi: 10.1007/s11604-024-01593-5. Online ahead of print.

Affiliations

¹ Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan. h.hirasawa@gunma-u.ac.jp.
² Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
³ Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁴ Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁵ Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, Maebashi, Japan.

PMID: 38795287
DOI: 10.1007/s11604-024-01593-5

Abstract

Purpose: Dialysis patients are at an increased risk of developing renal cell carcinoma (RCC); however, differentiating between RCC and benign cysts can sometimes be difficult using modalities, such as computed tomography (CT) and ultrasonography. ¹⁸F-Fluorodeoxyglucose positron emission tomography (FDG-PET)/CT efficiently detects malignant tumors; however, physiological accumulation of FDG in the kidney limits its efficacy in detecting renal tumors. However, in patients with severely impaired renal function, the renal accumulation of FDG is decreased, possibly improving the detection of renal malignancies in this patient population. This study evaluated the usefulness of FDG-PET/CT as a screening tool for detecting RCC in patients with end-stage renal disease.

Materials and methods: This prospective study recruited 150 participants from 2012 to 2016 who were on dialysis or underwent renal transplantation and were on dialysis until transplantation. FDG-PET/CT was performed to screen for RCC. Three radiologists independently evaluated the images. No protocol was defined for the additional management of positive examinations, leaving decisions to the discretion of each participant. Negative examinations were observed until the end of 2019.

Results: In total, 150 participants (mean age, 58 ± 13 years; 105 men) underwent FDG-PET/CT. Twenty patients (13.4%) were diagnosed as positive. Fifteen patients underwent additional examinations and/or procedures, and RCC was found in seven patients. Of the four patients who underwent surgical resection, the pathological results were clear cell RCC in one, papillary RCC in one, and acquired cystic disease-associated RCC in two. Two participants were diagnosed with RCC on bone biopsy, and one was diagnosed on dynamic CT but opted for observation. The sensitivity, specificity, and negative predictive value were 100%, 93.9%, and 100%, respectively.

Conclusion: FDG-PET/CT was useful for detecting RCC in patients with end-stage renal disease. Our findings show the potential use of FDG-PET/CT as a screening tool for RCC in this patient population.

Keywords: End-stage renal disease; FDG-PET/CT; Renal cell carcinoma; Screening.