J Nucl Med. 2007; 48 (Supplement 2):271P
General Clinical Specialties: Endocrinology
Endocrinology Posters |
FDG-PET/CT: A new tool to avoid unnecessary surgery of benign adrenal lesion?
Catherine Ansquer1,
David Taïeb2,
Emeric Abet3,
Eric Mirallié3,
Laurent Brunaud4,
Frédéric Sebag5,
Françoise Kraeber-Bodéré1 and
Pierre Olivier6
1 Nuclear Medicine, University Hospital, Nantes, France; ;
2 Nuclear Medicine, University Hospital, Marseille, France; ;
3 Surgery Department, University Hospital, Nantes, France; ;
4 Surgery Department, University Hospital, Nancy, France; ;
5 Surgery Department, University Hospital, Marseille, France; ;
6 Nuclear Medicine, University Hospital, Nancy, France
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Objectives: Surgery for adrenal lesion is decided on morphologic imaging and biological criteria. This prospective study was conducted to assess benefit of FDG-PET/CT in therapeutic decision in adrenal tumors. Methods: 62 patients (31 M, 31 F) with unilateral adrenal lesion underwent a whole body PET-scan 60 min after injection of 5 MBq/kg of 18FDG on an integrated in-line PET/CT system. A CT scan and biological tests were performed and possibly completed by 131I-mIBG and/or 131I-norcholesterol scans or MRI. A FDG uptake exceeding liver uptake was considered as a positive result and was compared to the usual surgical criteria: size 
3cm, spontaneous attenuation value >10 HU, heterogeneous aspect, uptake of mIBG, discordant or concordant and extinctive uptake of norcholesterol or hormonal hypersecretion. According to these criteria, 53 patients were operated on. Results: According to pathology or follow up (9 patients), 34 lesions were retrospectively defined as canditates for surgery (malignant =17, benign hypersecreting =17) and 38 (benign not hypersecreting) as not canditates for surgery. All lesions candidates for surgery and 79% of the lesions not candidates for surgery had at least 1 surgical criterion, indicating a low specificity of conventional criteria. PET was negative in 86% of lesions not candidates for surgery. PET was positive in 65% lesions candidates for surgery: 15/17 malignant lesions (9 adrenocortical carcinomas, 6 metastases, 1 lymphoma, 1 pheochromocytoma), 7/17 benign hypersecreting lesions (5 pheochromocytomas, 1 adrenal Cushing adenoma, 1 aldosteronoma). PET was falsely negative in 2 adrenal metastases of renal origin. Conclusions: These results showed that an adrenal FDG uptake is an indicator of malignant and/or hypersecreting lesion and should lead to surgery. In absence of previous poorly FDG-avid cancer (especially renal cancer), no FDG uptake should permit to avoid unnecessary surgery for many patients with benign adrenal lesion.
