ECE2023 Poster Presentations Adrenal and Cardiovascular Endocrinology (72 abstracts)
Diagnostic accuracy of 18F-FDG PET/TC for the characterization of adrenal lesions in a heterogeneous population
Martina Romanisio 1 , Tommaso Daffara 1 , Rosa Pitino 1 , Alice Ferrero 1 , Marco Zavattaro 1 , Federica Biello 2 , Alessandra Gennari 2 , Gian Mauro Sacchetti 3 , Gianluca Aimaretti 1 , Flavia Prodam 1,4 & Marina Caputo 1,4
1Endocrinology, Department of Translational Medicine, Novara, Italy; 2Oncology, Department of Translational Medicine, Novara, Italy; 3Department of Nuclear Medicine, Novara, Italy; 4Department of Health Sciences, Novara, Italy
Purpose: Diagnosis of adrenal lesions requires hormonal investigation and morphological characterization; when CT and MRI imaging are equivocal, 18F-FDG-PET/CT could be a useful tool, although sensitivity and specificity varied among cohorts. The use of tumour-to-liver maximum standardized uptake values (SUVratio) was found to be accurate, but the best threshold value has not been identified yet. A SUVratio > 1.5 was associated with malignancy with a good performance. The aim of the study was to evaluate the performance of the SUVratio > 1.5 in our heterogenous population.
Patients and methods: Retrospective analysis of Endocrinology, Surgery and Oncological Units on patients who received care for adrenal lesions (2013-2022). The cohort was narrowed down to patients who underwent 18F-FDG-PET/CT to assess the risk of malignancy for adrenal nodules. Benignity was defined by histology or when the lesion remained stable or had a minimal increase in diameter (<20% and <5 mm) on the 12-month follow-up imaging. The performance of SUVratio > 1.5 proposed and the optimal SUVratio in our population was calculated by ROC curves.
Results: 177 patients with adrenal lesions were selected; of them, 36 underwent 18FDG-PET/CT and were included (17 M/19 F, age at diagnosis 61.2 ±11.7 years); 6 patients had bilateral lesions, leading to a total of 42 adrenal lesions (diameter 36.1 ±20.3 mm). Twenty-nine lesions were classified as benign, 11 as malignant and 2 as pheochromocytomas. Considering malignancies, 8 patients had adrenal metastases (2 of them bilateral) and 1 adrenocortical carcinoma (ACC). The diagnosis of adrenal masses with a SUVratio > 1.5 was: 10 adrenal metastases, 1 ACC, 2 non-functioning adrenal adenomas, 1 adrenal hyperplasia and 1 pheochromocytoma. In the whole population, the SUVratio agreed with the diagnosis in 38 cases (90.5%); in the 4 discordant cases with a SUVratio > 1.5 and non-malignant lesion, the diagnosis was: 2 non-functioning adenomas, 1 hyperplasia, and 1 pheochromocytoma. The SUVratio cut-off of 1.5 showed 100% Sn, 87% Sp, 73% PPV, and 100% NPV. The SUVratio cut-off calculated in our population was 1.55 (Sn 100%, Sp 73.7%, AUC 0.868), with similar values excluding both pheochromocytomas and metastases from the analysis (SUVratio cut-off 1.49, Sn 100%, Sp 96.3%, AUC 0.988).
Conclusion: 18F-FDG PET/CT could help in decision making process avoiding unnecessary surgery. The SUVratio cut-off of 1.5 has a good performance in a heterogenous population with adrenal lesions.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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