Cardiac amyloidosis is an infiltrative cardiomyopathy caused by the deposition of insoluble amyloid fibrils in the myocardium, leading to abnormal cardiac function and heart failure. Diagnosis is often challenging due to its diverse symptoms and related comorbidities. Although endomyocardial biopsy is the gold standard for diagnosis, a complete diagnostic approach often includes non-invasive methods such as Cardiac Magnetic Resonance (CMR) and nuclear medicine techniques. Nuclear medicine bone-seeking agents are useful for diagnosing the transthyretin (ATTR) amyloidosis subtype. CMR is especially useful when echocardiography results are inconclusive or for differentiating cardiac amyloidosis from other conditions like hypertrophic cardiomyopathy. CMR provides a comprehensive evaluation of morphological and functional abnormalities, inversion time, late gadolinium enhancement, and can include advanced techniques such as T1 mapping and extracellular volume quantification for diagnostic and prognostic purposes. This review outlines how CMR and nuclear medicine are integral to the diagnostic process for cardiac amyloidosis, emphasizing their crucial roles and the synergy between various diagnostic techniques in assessing suspected cases. ESSENTIALS: REQUIRED SUMMARY STATEMENT: Nuclear medicine PYP scans and CMR play a pivotal role in the non-invasive diagnosis of cardiac amyloidosis, alongside other essential diagnostic modalities.

ABSTRACT:Metabolic tumor volume (MTV) assessed using 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography, a measure of tumor burden, is a promising prognostic indicator in large B-cell lymphoma (LBCL). This exploratory analysis evaluated relationships between baseline MTV (categorized as low [median or less] vs high [greater than median]) and clinical outcomes in the phase 3 ZUMA-7 study (NCT03391466). Patients with LBCL relapsed within 12 months of or refractory to first-line chemoimmunotherapy were randomized 1:1 to axicabtagene ciloleucel (axi-cel; autologous anti-CD19 chimeric antigen receptor T-cell therapy) or standard care (2-3 cycles of chemoimmunotherapy followed by high-dose chemotherapy with autologous stem cell transplantation in patients who had a response). All P values are descriptive. Within high- and low-MTV subgroups, event-free survival (EFS) and progression-free survival (PFS) were superior with axi-cel vs standard care. EFS in patients with high MTV (vs low MTV) was numerically shorter with axi-cel and was significantly shorter with standard care. PFS was shorter in patients with high MTV vs low MTV in both the axi-cel and standard-care arms, and median MTV was lower in patients in ongoing response at data cutoff vs others. Median MTV was higher in patients treated with axi-cel who experienced grade ≥3 neurologic events or cytokine release syndrome (CRS) than in patients with grade 1/2 or no neurologic events or CRS, respectively. Baseline MTV less than or equal to median was associated with better clinical outcomes in patients receiving axi-cel or standard care for second-line LBCL. The trial was registered at www.clinicaltrials.gov as #NCT03391466.

Purpose:Emerging data suggest that metastasis-directed therapy (MDT) improves outcomes in patients with oligometastatic castration-sensitive prostate cancer (omCSPC). Prostate-specific membrane antigen positron emission tomography (PSMA-PET) can detect occult metastatic disease, and PSMA response has been proposed as a biomarker for treatment response. Herein, we identify and validate a PSMA-PET biomarker for metastasis-free survival (MFS) following MDT in omCSPC.Methods and Materials:We performed an international multi-institutional retrospective study of patients with omCSPC, defined as ≤3 lesions, treated with metastasis-directed stereotactic ablative radiation who underwent PSMA-PET/computed tomography (CT) before and after (median, 6.2 months; range, 2.4-10.9 months) treatment. Pre- and post-MDT PSMA-PET/CT maximum standardized uptake value (SUVmax) was measured for all lesions, and PSMA response was defined as the percent change in SUVmax of the least responsive lesion. PSMA response was both evaluated as a continuous variable and dichotomized into PSMA responders, with a complete/partial response (at least a 30% reduction in SUVmax), and PSMA nonresponders, with stable/progressive disease (less than a 30% reduction in SUVmax). PSMA response was correlated with conventional imaging-defined metastasis-free survival (MFS) via Kaplan-Meier and Cox regression analysis.Results:A total of 131 patients with 261 treated metastases were included in the analysis, with a median follow-up of 29 months (IQR, 18.5-41.3 months). After stereotactic ablative radiation, 70.2% of patients were classified as PSMA responders. Multivariable analysis demonstrated that PSMA response as a continuous variable was associated with a significantly worse MFS (hazard ratio = 1.003; 95% CI, 1.001-1.006; P = .016). Patients classified as PSMA responders were found to have a significantly improved median MFS of 39.9 versus 12 months (P = .001) compared with PSMA nonresponders. Our study is limited as it is a retrospective review of a heterogenous population.Conclusions:After stereotactic ablative radiation, PSMA-PET response appears to be a radiographic biomarker that correlates with MFS in omCSPC. This approach holds promise for guiding clinical management of omCSPC and should be validated in a prospective setting.

Despite the significant progress achieved with PD-1/PD-L1 inhibitors in the treatment of metastatic renal cell carcinoma (mRCC), most patients ultimately progress. Targeted radiotheranostics offer a new potential approach. Although a radiotheranostic platform targeting the prostate-specific membrane antigen (PSMA) has been tested in mRCC in patients preliminarily, thorough preclinical optimization has not been reported. Prostate-specific membrane antigen (PSMA) is overexpressed in tumor-associated neovascular endothelial cells of many solid tumors, including metastatic RCC. Furthermore, radiopharmaceutical therapy using β- and α-particle emitting agents causes immunomodulation by inducing immunogenic cell death, and release of tumor-associated antigens, potentially enhancing inflammatory phenotype. Here, we investigated whether PSMA-based radiotheranostics can be utilized to improve the efficacy of PD-1 therapy. The PSMA+ RENCA model was developed by lentiviral transduction of RENCA (wt) cells and then characterized for basal and IFN-g induced PD-L1 expression. 68Ga-L1 and 225Ac-L1 were synthesized in high radiochemical yield and purity following our reported methods. Male and female BALB/c mice were used for tumor inoculation. 68Ga-L1 was evaluated in small animal PET/CT imaging in flank and PET/MR imaging in orthotopic implantation. A treatment study was conducted to assess the effect of combination therapy in seven groups in the flank tumors at 2 weeks post-inoculation: Control (saline); PD-1 (10 mg/kg); Anti-PD-1 (10 mg/kg)+axitinib (tyrosine kinase inhibitor, 5 mg/kg, oral gavage, for five days/wk); 225Ac-L1 (37 kBq); 225Ac-L1 (2×37 kBq, 1 wk apart); [225Ac-L1 (37 kBq)+PD-1 (10 mg/kg) and [225Ac-L1 2×37 kBq)+PD-1 (10 mg/kg)]. Therapeutic efficacy was assessed by tumor weight and time to progression of tumor volume doubling (TVD). To determine the mechanism of action of the 225Ac-L1/anti-PD-1 combination treatment, tumor-infiltrating lymphoid populations from tumor samples were collected at day 30, and Fluorescence-Activated Cell Sorting analysis was done with fluorochrome-labeled antibodies against CD45, CD3, CD8, IL10, and IL12. 68Ga-L1 and 225Ac-L1 confirmed 10-fold and 2-fold higher uptake, respectively, in the PSMA+ RENCA cells compared to RENCA (wt) cells. PET imaging in the flank model displayed ~7-fold higher accumulation of 68Ga-L1 in PSMA+ RENCA than the RENCA (wt). Two-fold higher accumulation of 68Ga-L1 was observed in orthotopic tumors than the normal kidneys during 1-3 h post-injection. Significant lung metastases were detected with 68Ga-L1 PET at 3 weeks in mice with orthotopic tumors. A combination therapy study was conducted using anti-PD-1 and anti-PD-1+axitinib and compared the efficacy with 225Ac-L1 as a single agent (37 kBq and 2×37 kBq, 1 wk apart) and in combination with PD-1. Median TVD increased from 12 d (control) to 16 d (anti-PD-1), 16 d (anti-PD-1+axitinib), 24 d [225Ac-L1 (37 kBq) P<0.001], 24 d [225Ac-L1 (2 × 37 kBq) P<0.0001}, 30 d [anti-PD-1+225Ac-L1 (1×37 kBq) P<0.0001], and undefined, [anti-PD-1+225Ac-L1 2×37 kBq), P<0.0001], respectively. Furthermore, treatment with 225Ac-L1 (2×37 kBq, 1 wk) resulted in a significant lowering of tumor growth (P< 0.01) compared to control, whereas anti-PD-1 (vs. control) alone moderately reduced tumor growth. The combination of the treatment of [PD-1+225Ac-L1 (2×37 kBq), P=0.0001] was the most effective in enhancing tumor growth inhibition compared with the PD-1+axitinib group. Flow cytometry of tumor-infiltrating immune cells of the treatment groups PD-1+225Ac-L1(37 kBq) and PD-1+225Ac-L1 (2×37 kBq) revealed a higher proportion of effector CD3+CD8+ T cells, accompanied by a significant decline in the proportion of immunosuppressive and pro-tumoral CD8+IL10+ T cells and increase in antitumor CD8+IL12+ T cells compared to untreated and treatment control groups (PD-1 or PD-1+axitinib groups). Combining radiotheranostic platform, 68Ga-L1/225Ac-L1 with PD-1 therapy reduces tumor burden and improves TVD in a syngeic model of RCC. This is a promising option for metastatic RCC patients with low and heterogeneous PSMA expression. Translation of this method will be pursued actively. DOD CDMRP Funding: yes

INTRODUCTION:The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. 99mTc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of 99mTc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of 99mTc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial. METHODS AND ANALYSIS:A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo 99mTc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for 99mTc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of 99mTc-sestamibi SPECT/CT. ETHICS AND DISSEMINATION:Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally. TRIAL REGISTRATION NUMBER:ISRCTN12572202.

In metastatic castration-sensitive prostate cancer (mCSPC), disease volume plays an integral role in guiding treatment recommendations, including selection of docetaxel therapy, metastasis-directed therapy, and radiation to the prostate. Although there are multiple definitions of disease volume, they have commonly been studied in the context of metastases detected via conventional imaging (CIM). One such numeric definition of disease volume, termed oligometastasis, is heavily dependent on the sensitivity of the imaging modality. We performed an international multi-institutional retrospective review of men with metachronous oligometastatic CSPC (omCSPC), detected via either advanced molecular imaging alone (AMIM) or CIM. Patients were compared with respect to clinical , genomic features using the Mann-Whitney U test, Pearson's x(2) test , Kaplan-Meier overall survival (OS) analyses with a log-rank test. A total of 295 patients were included for analysis. Patients with CIM-omCSPC had significantly higher Gleason grade group (p = 0.032), higher prostate-specific antigen at omCSPC diagnosis (8.0 vs 1.7 ng/ml; p < 0.001), more frequent pathogenic TP53 mutations (28% vs 17%; p = 0.030), and worse 10-yr OS (85% vs 100%; p < 0.001). This is the first report of clinical and biological differences between AMIM-detected and CIM-detected omCSPC. Our findings are partic-ularly important for ongoing and planned clinical trials in omCSPC. Patient summary: Metastatic prostate cancer with just a few metastases only detected via newer scanning methods (called molecular imaging) is associated with fewer high -risk DNA mutations and better survival in comparison to metastatic cancer detected via conventional scan methods.

61 Background: Piflufolastat F 18 is a PSMA-targeted radiopharmaceutical approved in the US for imaging prostate cancer (PCa) patients both at the time of initial staging and at disease recurrence. In a phase 3 study of patients with biochemically recurrent (BCR) PCa, we reported that nearly two-thirds (63.9%; 131/205) of participants had a change in their intended disease management plan based on pre- and post-piflulfolastat F 18 PET/CT management questionnaires (MMQs) completed by the treating physicians. The clinical utility of piflufolastat F 18 scanning in men with very low/low PSA levels (<0.5 ng/mL) and a detection rate of ~36% has not been previously described. Here we report the changes in intended management in this subset of patients. Methods: Men ≥18 years of age with a rising PSA after definitive PCa therapy and negative or equivocal imaging were enrolled. A single ~9 mCi (333 MBq) dose of piflufolastat F 18 was administered followed by PET/CT from mid-thigh through skull vertex 1-2 hours later. Prior to scanning, the treating physicians completed a pre-PET MMQ to document the initial intended management plan for their patients based on available clinical information including baseline conventional imaging results. After PET, they completed a post-PET MMQ and recorded the management plan in light of PET findings. Treatment recommendations that differed from the pre-scan recommendations were reported as changes in the intended management plan. Results: 208 men (median PSA 0.8 ng/mL [range 0.17-98.45], n=202) underwent piflufolastat F 18-PET/CT. 200 evaluable patients had both a baseline PSA value and completed MMQs. Of 131 patients with a recorded change in intended management, 127 had an evaluable baseline PSA level. Of the 69 patients with baseline PSA levels ≤0.5ng/mL, 27 (39.1%) recorded a change in intended disease management based on positive (n=20) or negative (n=7) PET, including salvage local to systemic therapy (n=15); systemic to local therapy (n=3); observation to treatment (n=5); and treatment to observation (n=4). An additional 15 patients (21.7%) had recommended bidirectional change in management (e.g., salvage RT+ADT) and are excluded in this report. Specific treatment intensification/de-intensification plans are under investigation. Conclusions: The frequency of changes in intended disease management observed in BCR PCa patients with low baseline PSA levels (≤0.5ng/mL) was 39.1%. Both negative and positive PET/CT results impacted treatment recommendations and can provide useful and actionable information. Clinical trial information: NCT02981368 .

You have accessJournal of UrologyCME1 Apr 2023PD43-05 IMMUNOMODULATORY RESPONSE TO NEOADJUVANT NIVOLUMAB IN NON-METASTATIC CLEAR CELL RENAL CELL CARCINOMA: RESULTS FROM a PHASE I TRIAL Nirmish Singla, Thomas Nirschl, Aleksandar Obradovic, Eugene Shenderov, Kara Lombardo, Xiaopu Liu, Alice Pons, Jelani Zarif, Steven Rowe, Bruce Trock, Hans Hammers, Trinity Bivalacqua, Phillip Pierorazio, Julie Deutsch, Tamara Lotan, Janis Taube, Yasser Ged, Michael Gorin, Mohamad Allaf, and Charles Drake Nirmish SinglaNirmish Singla More articles by this author , Thomas NirschlThomas Nirschl More articles by this author , Aleksandar ObradovicAleksandar Obradovic More articles by this author , Eugene ShenderovEugene Shenderov More articles by this author , Kara LombardoKara Lombardo More articles by this author , Xiaopu LiuXiaopu Liu More articles by this author , Alice PonsAlice Pons More articles by this author , Jelani ZarifJelani Zarif More articles by this author , Steven RoweSteven Rowe More articles by this author , Bruce TrockBruce Trock More articles by this author , Hans HammersHans Hammers More articles by this author , Trinity BivalacquaTrinity Bivalacqua More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , Julie DeutschJulie Deutsch More articles by this author , Tamara LotanTamara Lotan More articles by this author , Janis TaubeJanis Taube More articles by this author , Yasser GedYasser Ged More articles by this author , Michael GorinMichael Gorin More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , and Charles DrakeCharles Drake More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Novel perioperative strategies are needed to reduce recurrence rates in patients undergoing nephrectomy for high-risk, non-metastatic clear cell renal cell carcinoma (ccRCC). We sought to (1) elucidate the effects of PD-1 inhibition on primary tumor-infiltrating and circulating immune cell populations in ccRCC and (2) correlate tumor microenvironment and circulating immune cell compositions with response to anti-PD-1 therapy. METHODS: We conducted a prospective, phase I trial of neoadjuvant nivolumab prior to nephrectomy in 15 evaluable patients with non-metastatic ccRCC. We leveraged tissue from this cohort to elucidate the effects of PD-1 inhibition on immune cell populations in ccRCC and correlate the evolving immune milieu with anti-PD-1 response using fluorescence-activated cell sorting, bulk RNA sequencing with protein activity inference, and enzyme-linked immunosorbent assay for circulating cytokines. RESULTS: We found that nivolumab durably promotes a pro-inflammatory state within the primary tumor, as evidenced by a sustained increase in the effector T cell phenotype and decreased representation of regulatory T cell subsets. Baseline immune infiltration within the primary tumor including T effector and myeloid enrichment along with angiogenic depletion correlates with nivolumab responsiveness. Nivolumab increases CTLA-4 expression in the primary tumor, and subsequent nephrectomy increases circulating concentrations of sPD-L1, sPD-L3 (sB7-H3), and s4-1BB. CONCLUSIONS: Our findings form the basis to consider neoadjuvant immune checkpoint inhibition (ICI) for high-risk ccRCC while the tumor remains in situ and provide the rationale for perioperative strategies of novel ICI combinations. Source of Funding: Bristol Myers Squibb © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1119 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nirmish Singla More articles by this author Thomas Nirschl More articles by this author Aleksandar Obradovic More articles by this author Eugene Shenderov More articles by this author Kara Lombardo More articles by this author Xiaopu Liu More articles by this author Alice Pons More articles by this author Jelani Zarif More articles by this author Steven Rowe More articles by this author Bruce Trock More articles by this author Hans Hammers More articles by this author Trinity Bivalacqua More articles by this author Phillip Pierorazio More articles by this author Julie Deutsch More articles by this author Tamara Lotan More articles by this author Janis Taube More articles by this author Yasser Ged More articles by this author Michael Gorin More articles by this author Mohamad Allaf More articles by this author Charles Drake More articles by this author Expand All Advertisement PDF downloadLoading ...

Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50–70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.

Much of the modern growth in nuclear medicine has been driven by PET imaging of prostate-specific membrane antigen (PSMA) in men with prostate cancer. Fluorine-18 is the ideal PET radionuclide with a moderately long half-life, high positron yield, low positron energy, and cyclotron-based production. 18F-DCFPyL is the first Food and Drug Administration-approved compound in this class. In this review, we cover a number of aspects of radiofluorinated PSMA PET agents, including their historical development, the early clinical trials, key multicenter registration trials, emerging clinical agents, new compounds that are entering human use, and future directions for the field.

You have accessJournal of UrologyCME1 May 2022MP33-05 DIAGNOSTIC PARAMETERS OF 99mTC-SESTAMIBI SPECT/CT FOR RENAL ONCOCYTOMAS AND HYBRID ONCOCYTIC/CHROMOPHOBE TUMORS: COMBINED PROSPECTIVE TRIAL DATA Alexa Meyer, Hiten Patel, Lilja Solnes, Reema Goel, Mehrbod Javadi, Phillip Pierorazio, Christian Pavlovich, Mohamad Allaf, Michael Gorin, and Steven Rowe Alexa MeyerAlexa Meyer More articles by this author , Hiten PatelHiten Patel More articles by this author , Lilja SolnesLilja Solnes More articles by this author , Reema GoelReema Goel More articles by this author , Mehrbod JavadiMehrbod Javadi More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , Christian PavlovichChristian Pavlovich More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , Michael GorinMichael Gorin More articles by this author , and Steven RoweSteven Rowe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previously, we reported the results of our prospective trial of 50 patients imaged with 99mTc-sestamibi SPECT/CT prior to surgical resection, and showed that 99mTc-sestamibi SPECT/CT can aid in the differentiation of benign renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) from other renal tumor histologies. Here, we present the following 75 patients in the prospective trial cohort. The objective of this study was to determine the diagnostic performance of this imaging test using data from the overall cohort. METHODS: Patients presenting with a solid T1 renal mass were imaged with 99mTc-sestamibi SPECT/CT prior to surgery. For the new 75 patients in the cohort, SPECT/CT scans were analyzed by two readers, and discrepancies were resolved by a third reader. Tumors were characterized as positive (i.e. “hot”) or negative (i.e. “cold”). Radiotracer uptake was quantified. Following surgical resection, the cases were reviewed by genitourinary pathologists. Diagnostic parameters were calculated for the novel patients, as well as for the overall cohort. True positive was defined as any tumor diagnosed as an oncocytoma or HOCT following surgical resection. RESULTS: In total, 125 patients were enrolled in the trial. 1 tumor was non-diagnostic on imaging secondary to bowel overlying the tumor, and was excluded from analysis. In the novel 74 patients, 99mTc-sestamibi SPECT/CT correctly identified 9/12 oncocytomas and HOCTs, resulting in sensitivity of 75.0% (95% CI 42.8-94.5). 10 tumors were false positives (FP), resulting in specificity of 83.9% (95% CI 72.3-92.0). These included 5 papillary renal cell carcinomas (RCC), 3 chromophobe RCC, 1 low grade RCC with oncocytic features, and 1 angiomyolipoma. The positive predictive value (PPV) was 47.4% (95% CI 24.4-71.1) and negative predictive value (NPV) was 94.5% (84.9-98.9%). For the combined cohort of 124 patients, 99mTc-sestamibi SPECT/CT correctly identified 16/20 oncocytomas and HOCTs, resulting in sensitivity of 80.0% (95% CI 56.3-94.3). 12 tumors were FP, resulting in specificity of 88.5% (95% CI 80.7-93.9). The additional 2 FP were chromophobe RCC. The overall PPV was 57.1% (95% CI 37.2-75.5) and NPV was 95.8% (89.7-98.9%). CONCLUSIONS: Data from this prospective trial shows that 99mTc-sestamibi SPECT/CT can aid in the risk stratification of small renal masses. A “hot” 99mTc-sestamibi SPECT/CT should proceed to biopsy for further work-up. A “cold” 99mTc-sestamibi SPECT/CT can avoid biopsy and proceed directly to surgery. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e571 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexa Meyer More articles by this author Hiten Patel More articles by this author Lilja Solnes More articles by this author Reema Goel More articles by this author Mehrbod Javadi More articles by this author Phillip Pierorazio More articles by this author Christian Pavlovich More articles by this author Mohamad Allaf More articles by this author Michael Gorin More articles by this author Steven Rowe More articles by this author Expand All Advertisement PDF DownloadLoading ...