(18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value

Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. (18)F-FDG PET ((18)F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid t...

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Bibliographic Details
Published in:World journal of surgery 2013-01, Vol.37 (1), p.107-112
Main Authors: Tessonnier, L, Ansquer, C, Bournaud, C, Sebag, F, Mirallié, E, Lifante, J C, Palazzo, F F, Morange, I, Drui, D, de la Foucardère, C, Mancini, J, Taïeb, D
Format: Article
Language:English
Subjects:
Adrenal Cortex Neoplasms - diagnostic imaging
Adrenal Cortex Neoplasms - pathology
Adult
Aged
Aged, 80 and over
Female
Fluorodeoxyglucose F18
Humans
Male
Middle Aged
Neoplasm Staging
Positron-Emission Tomography
Prognosis
Radiopharmaceuticals
Retrospective Studies
Young Adult
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Summary:Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. (18)F-FDG PET ((18)F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, (18)F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative (18)F-FDG PET based on SUVs assessments has a prognostic value in ACC patients. A retrospective analysis was performed in patients who underwent (18)F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; (18)F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All (18)F-FDG PET/CT procedures were reinterpreted in a blind fashion. Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)(max) = 11 (range: 3-56) and a tumor/liver SUV(max) ratio = 4.2 (range: 1.3-15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. (18)F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis. At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values.
ISSN:1432-2323
DOI:10.1007/s00268-012-1802-y