A Closer Look at New Guidelines for Molecular Imaging of Renal Masses: An Interview with Steven Rowe, MD, Part 1

While there are different scoring systems, such as the MRI clear cell likelihood score, in place for assessing renal masses, Steven Rowe, M.D., noted questions about reproducibility and “quite a bit” of overlapping enhancement between benign and malignant renal tumors with conventional imaging.

These challenges have led to empirical decisions to remove enhancing, indeterminate renal masses, noted Dr. Rowe in a recent interview with Diagnostic Imaging.

“(While this approach) is certainly going to get all the cancerous tumors, the problem is it does take out a lot of benign and indolent tumors as well to the tune of thousands of those a year in the U.S so lots of folks are missing kidneys or parts of kidneys that didn't necessarily need to,” pointed out Dr. Rowe, a professor of radiology and director of human subjects research at the University of Texas Southwestern Medical Center in Dallas.

Accordingly, Dr. Rowe recently served as the lead author of recently published guidelines on the use of molecular imaging for detection and characterization of renal masses. A collaborative effort between the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Nuclear Medicine (ACNM) and the European Association of Nuclear Medicine (EANM), the guidelines discuss key considerations and parameters for use of the mitochondrial imaging agent ^99mTc-sestamibi and the emerging carbonic anhydrase IX (CAIX)-targeting ⁸⁹Zr-girentuximab.

While the FDA recently asked for more information on ⁸⁹Zr-girentuximab, Dr. Rowe suggested the questions were focused more on the manufacturing of the agent and that data from the recent ZIRCON trial demonstrated the potential of ⁸⁹Zr-girentuximab for detection of clear cell renal cell carcinoma (ccRCC).

“(The) ZIRCON (trial) showed that that ⁸⁹Zr-girentuximab has about an 86 percent sensitivity and specificity for identifying clear cell renal cell carcinoma. I think the FDA was dutifully impressed by that data. I don't think they had any concerns about this agent bringing sort of value to patients and helping eventually (in) decision making for folks,” added Dr. Rowe.

(Editor’s note: For related content, see “Can CT-Based AI Radiomics Enhance Prediction of Recurrence-Free Survival for Non-Metastatic ccRCC?,” “Study for Emerging PET/CT Agent Reveals ‘New Standard’ for Detecting Clear Cell Renal Cell Carcinoma” and “Meta-Analysis Assesses Impact of PSMA PET/CT for Staging of Renal Cell Carcinoma.”)

For more insights from Dr. Rowe, watch the video below.