18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma.
BACKGROUND
The role of (18)F-labeled 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the post-operative monitoring of patients with adrenocortical carcinoma (ACC) is still unclear.


OBJECTIVE
To assess the accuracy of FDG PET/CT to diagnose ACC recurrence in a real world setting.


METHODS
Retrospective evaluation of data of 57 patients with presumed ACC recurrence at CT scan who underwent FDG PET/CT within a median time of 20 days. We compared the results of either FDG PET/CT or CT with a gold standard confirmation of recurrence (positive histopathology report of removed/biopsied lesions or radiological progression of target lesions at follow-up) to assess their diagnostic performance at different body sites to correctly categorize target lesions. We also assessed whether FDG PET/CT findings may be useful to inform the management strategy.


RESULTS
In 48 patients with confirmed ACC recurrence, we found that FDG PET/CT had lower sensitivity than CT in diagnosing liver and lung recurrences of ACC. FDG PET/CT had higher specificity than CT in categorizing liver lesions. FDG PET/CT had a greater positive likelihood ratio than CT to identify liver and abdominal ACC recurrences. The management strategy was changed based on FDG PET/CT findings in 12 patients (21.1%).


CONCLUSIONS
The greater sensitivity of CT may be partly expected due the specific inclusion criteria of the study; however, the greater specificity of FDG PET/CT was particularly useful in ruling out suspected ACC recurrences found by CT. Thus, use of FDG PET/CT as a second-line test in the post-operative surveillance of ACC patients following CT finding of a potential recurrence may have a significant impact on patient management.
A
A
Ardito
C
C
Massaglia
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
E
E
Pelosi
B
B
Zaggia
V
V
Basile
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
R
R
Brambilla
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
F
F
Vigna-Taglianti
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
E
E
Duregon
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
V
V
Arena
P
P
Perotti
Internal Medicine IDepartment of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, ItalyIRMETPET-CT Diagnostic Imaging Center, Turin, ItalyPublic HealthDepartment of Clinical and Biological SciencesPathologyDepartment of Oncology, San Luigi Hospital, University of Turin, Regione Gonzole, 10, 10043 Orbassano, Italy.
D
D
Penna
M
M
Terzolo
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D018268:Adrenocortical Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18