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

  • Catherine AnsquerEmail author
  • Sonia Scigliano
  • Eric Mirallié
  • David Taïeb
  • Laurent Brunaud
  • Fredéric Sebag
  • Christophe Leux
  • Delphine Drui
  • Benoît Dupas
  • Karine Renaudin
  • Françoise Kraeber-Bodéré
Original Article

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.

Keywords

Adrenal glands FDG PET/CT Adenoma Adrenocortical carcinoma Phaeochromocytoma 

Notes

Acknowledgments

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

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Catherine Ansquer
    • 1
    • 2
    Email author
  • Sonia Scigliano
    • 3
  • Eric Mirallié
    • 4
  • David Taïeb
    • 5
  • Laurent Brunaud
    • 6
  • Fredéric Sebag
    • 7
  • Christophe Leux
    • 8
  • Delphine Drui
    • 9
  • Benoît Dupas
    • 10
  • Karine Renaudin
    • 11
  • Françoise Kraeber-Bodéré
    • 1
    • 2
    • 12
  1. 1.Service de Médecine NucléaireCHU - Hôtel DieuNantes Cedex 1France
  2. 2.INSERM UMR 892, CRCNANantes Cedex 1France
  3. 3.Service de Médecine NucléaireCHU Nancy-BraboisVandoeuvre les NancyFrance
  4. 4.Service de Chirurgie EndocrinienneCHU - Hôtel DieuNantes Cedex 1France
  5. 5.Service de Médecine NucléaireCHU de la TimoneMarseille Cedex 5France
  6. 6.Service de Chirurgie EndocrinienneCHU Nancy-BraboisVandoeuvre les NancyFrance
  7. 7.Service de Chirurgie EndocrinienneCHU de la TimoneMarseille Cedex 5France
  8. 8.PIMESPCHU - Hôpital Saint JacquesNantes Cedex 1France
  9. 9.Service d’EndocrinologieCHU - Hôpital Nord LaënnecNantes Cedex 1France
  10. 10.Service de RadiologieCHU - Hôtel DieuNantes Cedex 1France
  11. 11.Service d’Anatomo-pathologieCHU - Hôtel DieuNantes Cedex 1France
  12. 12.Service de Médecine NucléaireCentre René GauducheauSaint Herblain CedexFrance

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