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Johns Hopkins gives nice snapshot of study on imaging test add-on for kidney tumors

Noninvasive Imaging Test Shown Accurate in Ruling Out Kidney Cancers

Our Review Summary

This release from Johns Hopkins reports on a small, preliminary trial that shows adding a diagnostic imaging technique called sestamibi SPECT/CT to CT or MRI imaging tests led to more accurate diagnosis of kidney tumors, and subsequently, fewer unnecessary surgeries for benign tumors. Sestamibi SPECT/CT is short for 99mTc-sestamibi single-photon emission computed tomography/computed tomography.

The release does many things very well, particularly in its discussion of the benefits of the technology and the study evidence. The release would have been even stronger with some more details of cost beyond saying it is inexpensive. Since the sestamibi SPECT/CT appeared to reduce the number of surgeries because of better tumor classification, it likely would be a huge cost savings to both patients and the health system.

 

Why This Matters

The ability to better classify tumors of the kidney and prevent unnecessary surgeries for benign tumors would be a boon for patients and the health care system.  If these results hold in a planned larger study, the Johns Hopkins radiologists’ research could lead to wider adoption of sestamibi SPECT/CT and a significant reduction in unneeded surgeries. 

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

This release notes several times that sestamibi SPECT/CT is inexpensive and widely available. It would have been good to include some cost estimates, particularly since reducing unneeded surgeries by the “thousands” presumably would be a huge cost savings.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The release states that “The addition of sestamibi SPECT/CT increased the reviewers’ diagnostic certainty in 14 of the 48 patients, or in nearly 30 percent of all cases,” and that “Conventional imaging combined with sestamibi SPECT/CT had a value of 0.85, while conventional imaging alone had a value of 0.60.” The release offers that “a value of 0.50 indicates that a diagnostic test is no better than chance,” to give readers a benchmark for comparison.

Does the news release adequately explain/quantify the harms of the intervention?

Not Applicable

The release does address harms in terms of reduced harms from adding the imagining technology to standard diagnostic tests:

“Even for patients whose tumors were not reclassified, the addition of sestamibi SPECT/CT increased physicians’ ability to more confidently classify malignant tumors, which reduces the risk of misdiagnosis and unnecessary surgery for all patients, the researchers say.”

However, the potential harms from the test itself are not mentioned. Like CT, the test involves the use of ionizing radiation known to increase the risk of cancer. Though often minor, the contrast imaging agents (also called tracers or “dye”) injected prior to the test can cause allergic reactions, headaches, chest pain, dizziness, and other reactions.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The release clearly states that the radiologists evaluating the imagery were unaware of the results of the surgery, that is, whether the tumors were cancerous or benign. It also states that “similarly ‘blinded’ pathologists analyzed the tumors without knowing the radiologists’ imaging results.”  This blinding of the researchers lends credibility to the findings even though the study itself involved a small number of participants.

Does the news release commit disease-mongering?

Satisfactory

No evidence of disease mongering here. The release provides a good discussion of why more accurate imaging is needed for kidney tumor diagnosis.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release didn’t mention a funder.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release describes the results of comparing the diagnostic accuracy of regular CT or MRI scans alone or with the addition of sestamibi SPECT/CT imaging. The release also states that the alternative to diagnostic certainty is surgery, even when it is unknown whether the tumor is malignant or non-cancerous.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The release notes in several places, including in the first sentence, that the technique is “widely available.” We know that to be true.

Does the news release establish the true novelty of the approach?

Satisfactory

The release states that radiologists at Johns Hopkins designed the approach of combining sestamibi SPECT/CT with CT or MRI to improve diagnostic accuracy in kidney tumors.

Sestamibi SPECT/CT itself is not new. It is the standard imaging choice for assessing problems with the parathyroid glands, which are adjacent to the thyroid gland.

Total Score: 7 of 9 Satisfactory

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