title: (18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value.
abstract: BACKGROUND
  Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. (18)F-FDG PET ((18)F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, (18)F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative (18)F-FDG PET based on SUVs assessments has a prognostic value in ACC patients.
  
  
  METHODS
  A retrospective analysis was performed in patients who underwent (18)F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; (18)F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All (18)F-FDG PET/CT procedures were reinterpreted in a blind fashion.
  
  
  RESULTS
  Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)(max) = 11 (range: 3-56) and a tumor/liver SUV(max) ratio = 4.2 (range: 1.3-15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. (18)F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis.
  
  
  CONCLUSIONS
  At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values.
authors.affiliation: Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13385 Marseille Cedex 5, France.
authors.forename: L
authors.initials: L
authors.lastname: Tessonnier
authors.forename: C
authors.initials: C
authors.lastname: Ansquer
authors.forename: C
authors.initials: C
authors.lastname: Bournaud
authors.forename: F
authors.initials: F
authors.lastname: Sebag
authors.forename: E
authors.initials: E
authors.lastname: Mirallié
authors.forename: J C
authors.initials: JC
authors.lastname: Lifante
authors.forename: F F
authors.initials: FF
authors.lastname: Palazzo
authors.forename: I
authors.initials: I
authors.lastname: Morange
authors.forename: D
authors.initials: D
authors.lastname: Drui
authors.forename: C
authors.initials: C
authors.lastname: de la Foucardère
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.forename: D
authors.initials: D
authors.lastname: Taïeb
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18