Why the study?
Adrenocortical carcinoma is a rare primary adrenal malignancy, and the relative performance of FDG-PET-CT compared to CECT in its diagnosis and management needed evaluation.
Does FDG-PET-CT improve diagnostic and staging accuracy compared to CECT in patients with suspected or diagnosed adrenocortical carcinoma?
Does FDG-PET-CT improve diagnostic and staging accuracy compared to CECT in patients with suspected or diagnosed adrenocortical carcinoma?
FDG-PET-CT demonstrates superior diagnostic and staging performance compared to CECT in adrenocortical carcinoma, frequently altering clinical management.
Purpose: Adrenocortical carcinoma (ACC) is a rare primary malignancy of the adrenal gland. The present study was aimed to compare the performance of fluoro-2-deoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) compared to contrast-enhanced computed tomography (CECT) in diagnosis and management of ACC. Materials and Methods: A retrospective analysis of the PET-CT studies from January 2010 to October 2020 was performed. Patients with adrenal lesions suspicious of ACC and diagnosed cases of ACC who underwent PET-CT for staging, restaging, and surveillance were reanalyzed. The PET-CT parameters were compared with the clinical, biochemical, histopathological, and CECT parameters. Results: The study included 96 scans performed in 77 patients (36 males, aged 40.4 ± 17.9 years). Of these, 55 scans were performed to diagnose and stage suspected ACC (30 of them diagnosed as ACC), 31 for restaging, and 10 scans for surveillance of ACC. PET/CT revealed metastases from an extra-adrenal primary in 5/55 patients. FDG-PET-CT had a sensitivity and specificity of 100% and 70% to diagnose ACC. Standardized uptake value-peak more than 5.4 had a sensitivity of 90.9% and specificity of 91.7% for differentiating ACC from non-ACC lesions, while tumor-to-liver ratio peak (TLRpeak) of 3.3 was most specific. PET-CT changed the staging in 23.3% of the patients with an accuracy of 100%. PET-CT changed the management plan in 25.8% of the patients during restaging with a sensitivity and specificity of 95.6% and 100%, respectively. For surveillance, CECT was as sensitive as PET-CT; however, PET-CT was more specific (100% vs. 97.9%). Conclusion: FDG-PET-CT performs better than CECT in the diagnosis, staging, restaging, and surveillance of ACC.
No takes yet. Share an insight, caveat, or question.
Krishnaraju et al. (2022) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: