Abstract
Purpose
The aim of this study was to determine the diagnostic accuracy of positron emission tomography (PET) in cancer patients undergoing adrenalectomy for presumed metastatic disease, utilizing the gold standard of histopathology.
Methods
We retrospectively reviewed all adrenalectomies for metastatic disease performed at our institution over the last 12 years. Preoperative PET scans were compared with final pathology reports. Statistical analyses were performed with Fisher’s exact test for categorical variables and Student’s t test for continuous variables.
Results
Forty-nine adrenalectomies were performed for metastatic disease. Thirty had preoperative PET imaging and were included in this analysis. Mean age was 65.5 ± 13.6 years (29–91) and 54 % were male. Mean size was 3.8 cm (0.4–7.1). Primary tumor distribution was 61 % (n = 17) pulmonary; 11 % (n = 3) breast; 7 % (n = 2) gastric; 7 % (n = 2) renal; and 4 % (n = 1) each of brain, lymphoma, melanoma, and uterine. Mean standardized uptake value (SUV) was 11 ± 7.3 (3.2–30.0). Final pathology revealed that 80 % (25/30) were positive for metastatic disease and 20 % (5/30) were negative. The positive predictive value of PET in correctly identifying adrenal metastatic disease was 83 % (24 true-positive cases and 5 false-positive cases); there was one false-negative PET. False-positive PET results were not correlated with sex (p = 0.35), age (p = 0.24), or maximum SUV units (p = 0.26).
Conclusions
The 20 % false-positive rate for PET-positive adrenalectomies performed for metastatic disease should warrant its inclusion in preoperative counseling to the patient and interaction with the treating oncologist.
Similar content being viewed by others
References
Moreno P, De la Quintana B, Musholt T, et al. Adrenalectomy for solid tumor metises: results of a multicenter European study. Surgery 2013;154:1215–22.
Sarela A, Murphy I, Coit D, Conlon K. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol. 2003;10:1191–6.
Strong V, D’Angelica M, Tang L, et al. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol. 2007;14:3392–400.
Hirayama T, Fujita T, Koguchi D et al. Laparoscopic adrenalectomy for metastatic adrenal tumor. Asian J Endosc Surg. 2014;7:43–7.
Boland G, Dwamena B, Jagtiani M, et al. Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology. 2011;259:117–26.
Harrison J, Ali A, Bonomi P, Prinz R. The role of positron emission tomography in selecting patients with metastatic cancer for adrenalectomy. Am Surg. 2000;66:432–7.
Erasmus JJ, Patz EF Jr, McAdams HP, et al. Evaluation of adrenal masses in patients with bronchogenic carcinoma using 18F-fluorodeoxyglucose positron emission tomography. AJR Am J Roentgenol. 1997;168:1357–60.
Metser U, Miller E, Lerman H, et al. 18F-FDG PET/CT in the evaluation of adrenal masses. J Nucl Med. 2006;47:32–7.
Okada M, Shimono T, Komeya Y, et al. Adrenal masses: the value of additional FDG-PET/CT in differentiating between benign and malignant lesions. Ann Nucl Med. 2009;23:349–54.
Mody M, Kazerooni E, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995;19:434–439.
Sharma K, Venkatesan A, Swerdlow D, et al. Image-guided adrenal and renal biopsy. Tech Vasc Interv Radiol. 2010;13:100–109.
Acknowledgment
The authors wish to thank Daniel Horwitz, MS, for his assistance with data retrieval.
Disclosure
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuritzkes, B., Parikh, M., Melamed, J. et al. False-Positive Rate of Positron Emission Tomography/Computed Tomography for Presumed Solitary Metastatic Adrenal Disease in Patients with Known Malignancy. Ann Surg Oncol 22, 437–440 (2015). https://doi.org/10.1245/s10434-014-4031-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-4031-9