This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Groussin, L. Articles by Tenenbaum, F. Search for Related Content PubMed PubMed Citation Articles by Groussin, L. Articles by Tenenbaum, F. Related Collections Adrenal and Hypertension Endocrine Oncology

¹⁸F-Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Adrenocortical Tumors: A Prospective Study in 77 Operated Patients

Institut National de la Santé et de la Recherche Médicale Unité 567, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Department of Endocrinology, Metabolism and Cancer (L.G., F.Ti., R.L., J.B., X.B.), 75014 Paris, France; Université Paris Descartes (L.G., S.Si., F.Ti., J.C., M.B., J.B., B.D., P.L., B.R., X.B.), 75006 Paris, France; Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Department of Endocrinology, Center for Rare Adrenal Diseases (L.G., G.A., R.L., J.B., X.B.), Departments of Pathology (F.Ti.), Radiology (S.Si., M.B., P.L.), Digestive and Endocrine Surgery (B.D.), Nuclear Medicine (B.R., F.Te.), Biostatistics Unit (J.C.), and INCa Comete Network (R.L., X.B.), 75014 Paris, France; Hôpital d’Instruction des Armées du Val de Grâce, Department of Nuclear Medicine (G.B., H.F.), 75005 Paris, France; Assistance Publique des Hôpitaux de Paris, Hôpital Saint Antoine, Endocrinology Unit (P.B.), 75012 Paris, France; Assistance Publique des Hôpitaux de Paris, Hôpital de Bicêtre, Department of Endocrinology and Reproduction (S.Sa.), 94275 Le Kremlin-Bicêtre, France; and Department of Nuclear Medicine, Centre René Huguenin, Université Versailles-St-Quentin (J.-L.A.), 92210 Saint Cloud, France

Address all correspondence and requests for reprints to: Dr. Lionel Groussin, Service des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014 Paris; France. E-mail: lionel.groussin{at}cch.aphp.fr.

Context: Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage.

Objective: The objective of the study was to evaluate the usefulness of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) to predict malignancy in patients without a previous history of cancer.

Design: This was a prospective, multicenter study from 2001 to 2006.

Setting: The study was conducted at a network of seven university hospitals in Paris.

Patients: Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38).

Main Outcome Measure: The degree of ¹⁸F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan.

Results: Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85–1.00) and 0.88 (95% confidence interval 0.75–0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: ¹⁸F-FDG PET correctly predicted the benignity in 13 of 15 ACAs.

Conclusions: In a multidisciplinary team approach, ¹⁸F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.

This article has been cited by other articles:

				R. Libe, F. Tissier, M. Bienvenu, L. Groussin, S. Joannidis, C. Hignette, B. Dousset, P. Legmann, M. Faraggi, B. Richard, et al. Adrenocortical Tumor with Two Distinct Elements Revealed by Combined 18F-Fluorodeoxyglucose Positron Emission Tomography and 131I Nor-Cholesterol Scintigraphy J. Clin. Endocrinol. Metab., October 1, 2009; 94(10): 3631 - 3632. [Full Text] [PDF]