title: Predictors of malignancy in patients with pheochromocytomas/paragangliomas: Asian Indian experience.
abstract: OBJECTIVE
  Malignant transformation of pheochromocytomas/paragangliomas (PCC/PGL) is a rare occurrence, and predictive factors for the same are not well understood. This study aims to identify the predictors of malignancy in patients with PCC/PGL.
  
  
  METHODS
  We performed a retrospective analysis of 142 patients with either PCC or PGL registered at our institute between 2000 and 2015. Records were evaluated for clinical parameters like age, gender, familial/syndromic presentation, symptomatic presentation, biochemistry, size, number and location of tumours and presence of metastases and mode of its diagnosis.
  
  
  RESULTS
  Twenty patients were found to have metastases; 13 had metastases at diagnosis and seven during follow-up. Metastases were detected by radiology (CT-neck to pelvis) in 11/20 patients (5/13 synchronous and 6/7 metachronous),131I-metaiodobenzylguanidine in five (2/12 synchronous and 3/6 metachronous) patients and18F-flurodeoxyglucose PET/CT in 15 (12/12 synchronous and 3/3 metachronous) patients. Malignant tumours were significantly larger than benign tumours (8.3 ± 4.1 cm, range: 3-22 cm vs 5.7 ± 2.3 cm, range: 2-14 cm, P = 0.0001) and less frequently metanephrine secreting. On linear regression analysis, tumour size and lack of metanephrine secretion were the independent predictors of malignancy.
  
  
  CONCLUSIONS
  Patients with primary tumour size >5.7 cm and lack of metanephrine secretory status should be evaluated for possible malignancy not only at diagnosis but also in the postoperative period. As compared to CT and131I-MIBG scan,18F-flurodeoxyglucose PET/CT analyses are better (sensitivity: 100%) for the diagnosis of metastases in our study.
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India drkrantimd@gmail.com.
authors.forename: Kranti
authors.initials: K
authors.lastname: Khadilkar
authors.affiliation: Department of EndocrinologyVydehi Institute of Medical Sciences and Research Center, Bangalore, India.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sarathi
authors.affiliation: Department of EndocrinologyMahatma Gandhi Hospital and Medical College, Jaipur, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kasaliwal
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Reshma
authors.initials: R
authors.lastname: Pandit
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Manjunath
authors.initials: M
authors.lastname: Goroshi
authors.affiliation: Radiation Medicine CentreBhabha Atomic Research Centre, Mumbai, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Malhotra
authors.affiliation: Department of General SurgerySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Abhay
authors.initials: A
authors.lastname: Dalvi
authors.affiliation: Department of Uro-oncologyTata Memorial Hospital, Mumbai, India.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Bakshi
authors.affiliation: Department of EndocrinologyPostgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
authors.affiliation: Department of EndocrinologyPt. B.D. Sharma PGIMS, Rohtak, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Rajput
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Vyankatesh
authors.initials: V
authors.lastname: Shivane
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Lila
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Tushar
authors.initials: T
authors.lastname: Bandgar
authors.affiliation: Department of EndocrinologySeth G S Medical College and KEM Hospital, Mumbai, India.
authors.forename: Nalini S
authors.initials: NS
authors.lastname: Shah
keywords: 18F-flurodeoxyglucose PET/CT; clinical predictors; malignant paraganglioma; malignant pheochromocytoma