目前影像技术在鉴别不确定性肾肿瘤中良性和恶性新生物的诊断准确性仍然不理想。本研究评估了99mTc-七叶草酸酯（SestaMIBI）单光子发射计算机断层扫描（SPECT/CT）在鉴别肾腺瘤和混合腺泡/染色体瘤（HOCT）与（1）其他所有肾脏病变和（2）所有恶性肾病变之间的诊断准确性。次要结果包括：（1）良性与恶性；（2）肾腺瘤和HOCT与明细胞（ccRCC）和乳头状（pRCC）肾细胞癌；以及（3）肾腺瘤和HOCT与染色体瘤（chRCC）肾细胞癌的区分。 我们检索了PubMed/MEDLINE、Embase和Web of Science数据库的文献，截止日期为2022年11月。遵循了PRISMA（系统评价和荟萃分析的优先报告项目）指南来确定符合条件的研究。研究包括了前瞻性和回顾性横断面研究，其中与肾肿瘤活检或手术后的组织学结果相比较了SestaMIBI SPECT/CT的发现。 总体而言，符合纳入标准的有8项研究，涉及489名患者的501个肾肿瘤。SestaMIBI SPECT/CT对肾腺瘤和HOCT与其他所有肾病变的敏感性和特异性分别为89％（95％可信区间[CI] 70-97％）和89％（95％ CI 86-92％）。值得注意的是，对肾腺瘤和HOCT与ccRCC和pRCC的区分，SestaMIBI SPECT/CT显示了98％（95％ CI 91-100％）的特异性和类似的敏感性。由于纳入的研究中存在相对较高的偏倚风险和异质性，证据水平仍然较低。 SestaMIBI SPECT/CT在鉴别肾腺瘤和HOCT与其他所有肾病变，特别是与更具侵袭性肿瘤行为的病变之间具有良好的敏感性和特异性。尽管这些结果很有希望，但仍需要进一步研究支持SestaMIBI SPECT/CT在研究试验之外的应用。 版权所有 © 2023 欧洲泌尿外科协会。由Elsevier B.V.出版，保留所有权利。

The diagnostic accuracy of current imaging techniques in differentiating benign from malignant neoplasms in the case of indeterminate renal masses is still suboptimal.To evaluate the diagnostic accuracy of 99mTc-sestamibi (SestaMIBI) single-photon emission tomography computed tomography (SPECT)/CT in characterizing indeterminate renal masses by differentiating renal oncocytoma and hybrid oncocytic/chromophobe tumor (HOCT) from (1) all other renal lesions and (2) all malignant renal lesions. Secondary outcomes were: (1) benign versus malignant; (2) renal oncocytoma and HOCT versus clear cell (ccRCC) and papillary (pRCC) renal cell carcinoma; and (3) renal oncocytoma and HOCT versus chromophobe renal cell carcinoma (chRCC).A literature search was conducted up to November 2022 using the PubMed/MEDLINE, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify eligible studies. Studies included were prospective and retrospective cross-sectional studies in which SestaMIBI SPECT/CT findings were compared to histology after renal mass biopsy or surgery.Overall, eight studies involving 489 patients with 501 renal masses met our inclusion criteria. The sensitivity and specificity of SestaMIBI SPECT/CT for renal oncocytoma and HOCT versus all other renal lesions were 89% (95% confidence interval [CI] 70-97%) and 89% (95% CI 86-92%), respectively. Notably, for renal oncocytoma and HOCT versus ccRCC and pRCC, SestaMIBI SPECT/CT showed specificity of 98% (95% CI 91-100%) and similar sensitivity. Owing to the relatively high risk of bias and the presence of heterogeneity among the studies included, the level of evidence is still low.SestaMIBI SPECT/CT has good sensitivity and specificity in differentiating renal oncocytoma and HOCT from all other renal lesions, and in particular from those with more aggressive oncological behavior. Although these results are promising, further studies are needed to support the use of SestaMIBI SPECT/CT outside research trials.A scan method called SestaMIBI SPECT/CT has promise for diagnosing whether kidney tumors are malignant or not. However, it should still be limited to research trials because the level of evidence from our review is low.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.