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Adrenal findings in FDG-PET: analysis of a cohort of 1021 patients from a cancer center

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Abstract 

Purpose

The use of FDG-PET for cancer staging has led to the increasing incidence of adrenal lesions, which are usually a clinical challenge. We aimed to characterize the adrenal lesions found in FDG-PET of patients followed in a cancer center.

Methods

Retrospective analysis was conducted of all FDG-PET studies performed in our center in the last 10 years. Exams reporting adrenal lesions in the CT component and/or anomalous adrenal FDG uptake were selected. Cases were characterized by the clinical, laboratory, imaging, and pathological findings.

Results

We identified 27,427 FDG-PET studies. Of those, 7.6% reported adrenal findings. We included 1364 exams corresponding to 1021 patients. Only 15.6% of the patients were referred to the Endocrinology Department and 38% of the lesions were not studied. In 38.9% of the studied patients, malignant lesions were present, including metastases in 37.5%, carcinoma in 1.2%, and other malignant tumors in 0.4%. The median SUVmax of malignant lesions was significantly higher than the SUVmax of the benign findings (p < 0.05). We also observed a higher median SUVmax in adrenal metastases than in adenomas (p < 0.05). There was a tendency for higher SUVmax of adrenal carcinomas when compared with other malignant lesions (p = 0.066). The median SUVmax was not different between pheochromocytomas and other tumors (p > 0.05).

Conclusion

Occult adrenal lesions discovered during FDG-PET/CT are common in the cancer context and are frequently benign. SUVmax may be a useful tool in the workup of adrenal lesions but with several important caveats.

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Authors and Affiliations

  1. Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

    Joana Maciel, Daniela Cavaco, Sara Donato, Helder Simões & Joana Simões-Pereira

  2. Nuclear Medicine Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal

    Davide Fraga & Rita Sousa

Authors
  1. Joana Maciel
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  2. Daniela Cavaco
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  3. Davide Fraga
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  4. Sara Donato
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  5. Helder Simões
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  7. Joana Simões-Pereira
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Correspondence to Joana Simões-Pereira.

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This study was approved by the Ethics Committee of our center.

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Informed consent was not mandatory by our Ethics Committee as this was a retrospective analysis of anonymous data.

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Maciel, J., Cavaco, D., Fraga, D. et al. Adrenal findings in FDG-PET: analysis of a cohort of 1021 patients from a cancer center. Hormones 22, 131–138 (2023). https://doi.org/10.1007/s42000-022-00423-5

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