18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients.
BACKGROUND
Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage.


OBJECTIVE
The objective of the study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) to predict malignancy in patients without a previous history of cancer.


METHODS
This was a prospective, multicenter study from 2001 to 2006.


METHODS
The study was conducted at a network of seven university hospitals in Paris.


METHODS
Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38).


METHODS
The degree of (18)F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan.


RESULTS
Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85-1.00) and 0.88 (95% confidence interval 0.75-0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs.


CONCLUSIONS
In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.
Groussin
Lionel
L
Institut National de la Santé et de la Recherche Médicale Unité 567, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Paris, France. lionel.groussin@cch.aphp.fr
Bonardel
Gérald
G
Silvéra
Stéphane
S
Tissier
Frédérique
F
Coste
Joël
J
Abiven
Gwenaelle
G
Libé
Rossella
R
Bienvenu
Marie
M
Alberini
Jean-Louis
JL
Salenave
Sylvie
S
Bouchard
Philippe
P
Bertherat
Jérôme
J
Dousset
Bertrand
B
Legmann
Paul
P
Richard
Bruno
B
Foehrenbach
Hervé
H
Bertagna
Xavier
X
Tenenbaum
Florence
F
D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006728:Hormones / Q000097:blood; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010297:Paris; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
D001786:Blood Glucose; D006728:Hormones; D019788:Fluorodeoxyglucose F18