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Risk stratification of adrenal masses by [ 18 F]FDG PET/CT: Changing tactics
Author(s) -
Salgues Betty,
Guerin Carole,
Amodru Vincent,
Pattou François,
Brunaud Laurent,
Lifante JeanChristophe,
Mirallié Eric,
Sahakian Nicolas,
Castinetti Frédéric,
Loundou Anderson,
Baumstarck Karine,
Sebag Fréderic,
Taïeb David
Publication year - 2021
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14338
Subject(s) - malignancy , medicine , cohort , standardized uptake value , context (archaeology) , nuclear medicine , radiology , positron emission tomography , paleontology , biology
Abstract Context [ 18 F]FDG PET/CT improves adrenal tumour characterization. However, there is still no consensus regarding the optimal imaging biomarkers of malignancy. Objectives To assess the performance of Tumour standardized uptake value (SUV) max :Liver SUV max for malignancy‐risk and to build and evaluate a prediction model. Design/Methods The cohort consisted of consecutive patients with adrenal masses evaluated by [ 18 F]FDG PET/CT. The gold standard for malignancy was based on histology or a multidisciplinary consensus in nonoperated cases. The performance of the previously reported cut‐off for Tumour SUV max :Liver SUV max (>1.5) was evaluated in this independent cohort. Additionally, a predictive model of malignancy was built from the training cohort (previous study) and evaluated in the validation cohort (current study). Results Sixty‐four patients were evaluated; 28% of them had a Cushing's syndrome. Fifty‐four adrenal masses were classified as benign and 10 as malignant (including 7 adrenocortical carcinomas). Compared to benign masses, malignant lesions were larger in size, had higher unenhanced densities and higher [ 18 F]FDG uptake. CT‐derived anthropometric parameters did not differ between benign and malignant masses. A tumour SUV max :Liver SUV max > 1.5 showed a good diagnostic performance: Se = 90.0%/Sp = 92.6%/PPV = 69.2%/NPV = 98.0% and accuracy = 92.2%. A predictive model based on tumour size and tumour‐to‐liver uptake SUV max ratio for malignancy‐risk was validated and provides a complementary approach to the ratio. Conclusions Tumour SUV max :Liver SUV max uptake ratio is a useful biomarker for diagnosis of adrenal masses. Another tactic would be to calculate with the model an individual risk of malignancy and integrate this information into a shared decision‐making process.