18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients
Abstract
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 (18)F-fluorodeoxyglucose positron emission tomography ((18)F-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 (18)F-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: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs. CONCLUSIONS: In a multidisciplinary team approach, (18)F-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.
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In a study of 77 patients with surgically proven ACA or ACC, [18F]FDG PET/CT had sensitivity 100% and specificity 88% for distinguishing benign from malignant lesions using a cutoff above 1.45 for adrenal to liver maximum SUV.
“In a study of 77 patients with surgically proven diagnosis of ACA or ACC, [18F]FDG PET/CT had a sensitivity of 100% and specificity of 88% in distinguishing benign from malignant lesions by using cutoff value above 1.45 for adrenal to liver maximum standardized uptake value (SUV).”
From Adrenocortical carcinoma (2014) · cites this paper as [108]
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Self-citation
- Authors
- Groussin, L., Bonardel, G., Silvéra, S., Tissier, F., Coste, J., Abiven, G., Libé, R., Bienvenu, M., Alberini, J.-L., Salenave, S., Bouchard, P., Bertherat, J., Dousset, B., Legmann, P., Richard, B., Foehrenbach, H., Bertagna, X., & Tenenbaum, F.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- HIA du Val-de-Grâce à Paris (FR)
- 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
- 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
- Hôpital Cochin (FR)
- Université Paris Descartes (FR)
- Université de Versailles Saint-Quentin-en-Yvelines (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Nuclear Medicine (B.R., F.Te.), 75014 Paris, France
- Corresponding author
- Groussin, Lionel
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-05-01
- Volume
- 94
- Issue
- 5
- Pages
- 1713-1722
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2044368873
- Cited by
- 215
- References
- 53
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 5 · 2023: 9 · 2022: 13 · 2021: 13 · 2020: 6 · 2019: 5 · 2018: 14 · 2017: 15 · 2016: 11 · 2015: 13 · 2014: 18 · 2013: 14 · 2012: 14
- FWCI
- 22.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- 18F-FDG PET, adrenocortical tumors, adrenocortical carcinoma, adrenal adenoma, adrenal incidentaloma, malignancy prediction, standardized uptake value, preoperative diagnosis
- MeSH terms
- Adrenal Cortex Neoplasms, Adult, Aged, Blood Glucose, Female, Hormones, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Paris, Preoperative Care, Prospective Studies, Tomography, X-Ray Computed, Fluorodeoxyglucose F18, Diabetes Complications, Positron-Emission Tomography
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