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Predicting malignancy in patients with adrenal tumors using 18 F‐FDG‐PET/CT SUVmax
Author(s) -
Vos Elvira L.,
Grewal Ravinder K.,
Russo Ashley E.,
ReidyLagunes Diane,
Untch Brian R.,
Gavane Somali C.,
Boucai Laura,
Geer Eliza,
Gopalan Anuradha,
Chou Joanne F.,
Capanu Marinela,
Strong Vivian E.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26203
Subject(s) - medicine , malignancy , standardized uptake value , nuclear medicine , cohort , positron emission tomography , radiology , cutoff , adrenal adenoma , adenoma , pathology , physics , quantum mechanics
Background and Objectives 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F‐FDG‐PET/CT) parameters may help distinguish malignant from benign adrenal tumors, but few have been externally validated or determined based on definitive pathological confirmation. We determined and validated a threshold for 18 F‐FDG‐PET/CT maximum standard uptake value (SUVmax) in patients who underwent adrenalectomy for a nonfunctional tumor. Methods Database review identified patients with 18 F‐FDG‐PET/CT images available (training cohort), or only SUVmax values (validation cohort). Discriminative accuracy was assessed by area under the curve (AUC), and the optimal cutoff value estimated by maximally selected Wilcoxon rank statistics. Results Of identified patients ( n = 171), 86 had adrenal metastases, 20 adrenal cortical carcinoma, and 27 adrenal cortical adenoma. In the training cohort ( n = 96), SUVmax was significantly higher in malignant versus benign tumors (median 8.3 vs. 3.0, p < .001), with an AUC of 0.857. Tumor size did not differ. The optimal cutoff SUVmax was 4.6 ( p < .01). In the validation cohort ( n = 75), this cutoff had a sensitivity of 75% and specificity 55%. Conclusions 18 F‐FDG‐PET/CT SUVmax was associated with malignancy. Validation indicated that SUVmax ≥ 4.6 was suggestive of malignancy, while lower values did not reliably predict benign tumor.