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18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This prospective multicentre study assesses the usefulness of FDG PET/CT in characterizing and making the therapeutic decision concerning adrenal tumours that are suspicious or indeterminate in nature after conventional examinations (CE).

Methods

Seventy-eight patients (37 men, 41 women, 81 adrenal lesions) underwent FDG PET/CT after CE including CT scan, biological tests and optionally 131I-metaiodobenzylguanidine (MIBG) and/or 131I-norcholesterol scans. FDG adrenal uptake exceeding that of the liver was considered positive. PET results were not decisive. Surgery was discussed when at least one of the following criteria was found during CE: size >3 cm, spontaneous attenuation value >10 HU, heterogeneous aspect, abnormal MIBG or norcholesterol scan or hormonal hypersecretion.

Results

Following the gold standard (histology analysis or ≥9 months follow-up), 49 lesions potentially qualified for surgery (malignant = 27, benign secreting = 22) and 32 benign non-secreting lesions did not. PET was negative in 97% of non-surgical lesions and positive in 73% of potentially surgical ones which included all the malignant lesions, except 3 renal cell metastases, and 12 of 22 benign secreting lesions. The negative predictive value for malignancy was 93% (41/44) and positive predictive value for detecting surgical lesions was 97% (36/37). A high FDG uptake (maximum standardized uptake value ≥ 10) was highly predictive of malignancy.

Conclusion

Adrenal FDG uptake is a good indicator of malignancy and/or of secreting lesions and should lead one to discuss surgery. If there is no prior history of poorly FDG-avid cancer, the absence of FDG uptake should avoid unnecessary removal of benign adrenal lesions.

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Acknowledgments

The authors thank Dr. Sylvie Collon for her kind assistance in revising the English of this manuscript.

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Authors and Affiliations

  1. Service de Médecine Nucléaire, CHU - Hôtel Dieu, Place A Ricordeau, 44093, Nantes Cedex 1, France

    Catherine Ansquer & Françoise Kraeber-Bodéré

  2. INSERM UMR 892, CRCNA, Quai Moncousu, BP 70721, 44007, Nantes Cedex 1, France

    Catherine Ansquer & Françoise Kraeber-Bodéré

  3. Service de Médecine Nucléaire, CHU Nancy-Brabois, Rue du Morvan, 54511, Vandoeuvre les Nancy, France

    Sonia Scigliano

  4. Service de Chirurgie Endocrinienne, CHU - Hôtel Dieu, Place A Ricordeau, 44093, Nantes Cedex 1, France

    Eric Mirallié

  5. Service de Médecine Nucléaire, CHU de la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France

    David Taïeb

  6. Service de Chirurgie Endocrinienne, CHU Nancy-Brabois, Rue du Morvan, 54511, Vandoeuvre les Nancy, France

    Laurent Brunaud

  7. Service de Chirurgie Endocrinienne, CHU de la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, France

    Fredéric Sebag

  8. PIMESP, CHU - Hôpital Saint Jacques, Rue St Jacques, 44093, Nantes Cedex 1, France

    Christophe Leux

  9. Service d’Endocrinologie, CHU - Hôpital Nord Laënnec, Boulevard J Monod, 44093, Nantes Cedex 1, France

    Delphine Drui

  10. Service de Radiologie, CHU - Hôtel Dieu, Place A Ricordeau, 44093, Nantes Cedex 1, France

    Benoît Dupas

  11. Service d’Anatomo-pathologie, CHU - Hôtel Dieu, Place A Ricordeau, 44093, Nantes Cedex 1, France

    Karine Renaudin

  12. Service de Médecine Nucléaire, Centre René Gauducheau, Boulevard J Monod, 44805, Saint Herblain Cedex, France

    Françoise Kraeber-Bodéré

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  1. Catherine Ansquer
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  2. Sonia Scigliano
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  3. Eric Mirallié
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Correspondence to Catherine Ansquer.

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Ansquer, C., Scigliano, S., Mirallié, E. et al. 18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation. Eur J Nucl Med Mol Imaging 37, 1669–1678 (2010). https://doi.org/10.1007/s00259-010-1471-8

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  • DOI: https://doi.org/10.1007/s00259-010-1471-8

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