Advancements in Imaging and Diagnosing Kidney Cancers: The Future Role of PET Imaging Agents

Panelists discuss how cross-sectional imaging with pre- and postcontrast assessment remains the cornerstone of renal mass imaging, though newer software technologies now allow for better prediction of benign vs malignant tumors.

Panelists discuss how evaluating a renal mass requires considering multiple factors, including patient expectations, comorbidities, life expectancy, tumor characteristics such as size and enhancement patterns, and predictive models to help guide decision-making.

Explore the strengths and weaknesses of imaging modalities like CT, MRI, and ultrasound in diagnosing ccRCC and enhancing patient care.

Explore treatment options for small renal masses, including surveillance, surgery, and biopsy, while understanding the role of ccRCC PET in diagnosis.

Explore the role of biopsies in managing ccRCC, especially in elderly patients, to optimize treatment decisions and preserve kidney function.

Imaging advancements in ccRCC are crucial for predicting tumor biology and enhancing treatment strategies through molecular imaging techniques.

Panelists discuss how deep learning applied to imaging data sets may advance kidney cancer assessment, though they believe the next major leap will require true molecular imaging that reveals what tumors are expressing.

Panelists discuss how PET imaging for kidney cancer includes prostate-specific membrane antigen, which is sometimes expressed in renal cell carcinoma, though its utility remains unclear, whereas fluorodeoxyglucose PET can be useful for metabolic activity assessment despite limitations with inflammatory lesions.

Panelists discuss how the ZIRCON trial demonstrated high positive predictive value (> 90%) for identifying clear cell renal cell carcinoma using a new molecular imaging agent, though negative predictive value was lower at approximately 70%.

Panelists discuss how the new tracing agent (Zr-DFO-girentuximab or 2050) works by binding to carbonic anhydrase IX, an enzyme expressed on the surface of most clear cell renal cancers, coupled with zirconium for radiographic detection.

Panelists discuss how the ZIRCON trial results showed impressive test characteristics with 95% positive predictive value for clear cell renal cell carcinoma, meaning a positive test strongly indicates cancer requiring treatment.

Panelists discuss how new molecular imaging technology offers potential to better risk stratify patients eligible for adjuvant pembrolizumab after surgery, potentially identifying those who have undetected metastatic disease requiring more aggressive treatment.

Panelists discuss how the new PET technology could identify lymph node involvement not visible on conventional imaging, providing actionable information for surgical planning or indicating the need for systemic therapy rather than surgery alone.

Panelists discuss how molecular imaging might help with complex renal mass decision-making, potentially identifying aggressive clear cell biology that would warrant radical rather than partial nephrectomy, though anatomical details would still require conventional imaging.

Panelists discuss how molecular imaging could transform metastatic kidney cancer management by helping determine whether cytoreductive nephrectomy is necessary and assessing treatment response to guide therapy escalation or de-escalation.

Panelists discuss how the logistical challenge of the new test requiring separate appointments (tracer injection followed by imaging 5 days later) is offset by scheduling flexibility because of the tracer’s 78-hour half-life and the technology essentially providing a “virtual biopsy” without invasive procedures.