Predicting malignancy in patients with adrenal tumors using ¹⁸F‐FDG‐PET/CT SUVmax

Background and Objectives 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F‐FDG‐PET/CT) parameters may help distinguish malignant from benign adrenal tumors, but few have been externally validated or determined based on definitive pathological confirmation. We determined and validated a threshold for 18 F‐FDG‐PET/CT maximum standard uptake value (SUVmax) in patients who underwent adrenalectomy for a nonfunctional tumor. Methods Database review identified patients with 18 F‐FDG‐PET/CT images available (training cohort), or only SUVmax values (validation cohort). Discriminative accuracy was assessed by area under the curve (AUC), and the optimal cutoff value estimated by maximally selected Wilcoxon rank statistics. Results Of identified patients ( n = 171), 86 had adrenal metastases, 20 adrenal cortical carcinoma, and 27 adrenal cortical adenoma. In the training cohort ( n = 96), SUVmax was significantly higher in malignant versus benign tumors (median 8.3 vs. 3.0, p < .001), with an AUC of 0.857. Tumor size did not differ. The optimal cutoff SUVmax was 4.6 ( p < .01). In the validation cohort ( n = 75), this cutoff had a sensitivity of 75% and specificity 55%. Conclusions 18 F‐FDG‐PET/CT SUVmax was associated with malignancy. Validation indicated that SUVmax ≥ 4.6 was suggestive of malignancy, while lower values did not reliably predict benign tumor.