THE DIAGNOSTIC ACCURACY OF PET/CT IN DIFFERENTIATING BENIGN FROM MALIGNANT ADRENAL GLAND NODULES IN CANCER PATIENTS WITH SUSPICIOUS ADRENAL NODULES USING HISTOPATHOLOGICAL AS GOLD STANDARD.

Main Article Content

Radha
Rabail Khaskheli
Shafaq Aijaz
Farida Zafar Shakir
Safia Ilyas
Kanwal
Neelam Maharjan

Keywords

Adrenal nodules, Positron Emission Tomography, Diagnostic accuracy, Oncologic patients

Abstract

Background: The adrenal gland, known for its metastatic propensity, often hosts accompanying lesions, making the distinction between malignancy and benign adenomas crucial in oncologic patients. Accurate characterization is vital, enabling informed management decisions and prognostic evaluations while minimizing unnecessary biopsies.


Objective: The study aimed to determine the diagnostic accuracy of Positron Emission Tomography/Computed Tomography (PET/CT) in differentiating between benign and malignant adrenal nodules in cancer patients with suspicious adrenal nodules, using histopathology as the gold standard at a Tertiary Care Hospital in Karachi.


Methodology: The study, designed as a cross-sectional investigation, took place at the Department of Radiology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Conducted over six months, from 26-03-21 to 26-09-21, the research involved the prospective collection of data from 123 patients meeting diagnostic criteria. Verbal consent was obtained, and the data was analyzed using simple descriptive statistics for quantitative variables and frequency percentages for qualitative variables. Sensitivity, specificity, positive and negative predictive values, along with diagnostic accuracy, were calculated for the assessment of the study's objectives.


Results: The study incorporated a total of 123 patients meeting the specified inclusion and exclusion criteria. The mean age of participants was 50.14±10.49 years, with a gender distribution of 63 (51.2%) males and 60 (48.8%) females. Analysis of the data revealed that among these patients, the diagnostic performance of PET/CT for identifying malignant adrenal nodules, using histopathology as the gold standard, resulted in a sensitivity of 89.7%, specificity of 86.6%, positive predictive value of 92.1%, negative predictive value of 82.9%, and an overall diagnostic accuracy of 88.6%.


Conclusion: PET/CT demonstrated good sensitivity and specificity for the characterization of adrenal masses.

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References

1. Sconfienza LM, Mauri G, Muzzupappa C. Relevant incidental findings at abdominal multi-detector contrast-enhanced computed tomography: a collateral screening? World J Radiol. 2015 Oct 28;7(10):350–56.
2. Johnson PT, Horton KM, Fishman EK. Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls. Radiographics. 2009 Sep-Oct;29(5):1333-51.
3. Chong S, Lee KS, Kim HY. Integrated PET-CT for the characterization of adrenal gland lesions in cancer patients: diagnostic efficacy and interpretation pitfalls. Radiographics. 2006 Nov-Dec;26(6):1811-24.
4. Fan J, Tang J, Fang J, , Li Q, He E, Li J et al. Ultrasound imaging in the diagnosis of benign and suspicious adrenal lesions. Med Sci Monit. 2014 Nov 3;20:2132-41.
5. Friedrich-Rust M, Glasemann T, Polta A, Eichler K, Holzer K, Kriener S, et al. Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound. Ultraschall Med. 2011 Oct;32(5):460-71.
6. Lattin GE Jr, Sturgill ED, Tujo CA Marko J, Sanchez-Maldonado KW, Craig WD, et al. From the radiologic pathology archives: adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics. 2014 May-Jun;34(3):805-29.
7. Agrons MM, Jensen CT, Habra MA, Menias CO, Shaaban AM, Wagner-Bartak NA et al. Adrenal cortical hyperplasia: diagnostic workup, subtypes, imaging features and mimics. Br J Radiol. 2017 Nov;90(1079):20170330.
8. Alshahrani MA, Bin Saeedan M, Alkhunaizan T, Aljohani IM, Azzumeea FM. Bilateral adrenal abnormalities: imaging review of different entities. Abdom Radiol (NY). 2019 Jan;44(1):154-79.
9. Ardito A, Massaglia C, Pelosi E, Zaggia B, Basile V, Brambilla R et al. 18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma. Eur J Endocrinol. 2015 Dec;173(6):749-56.
10. Kim JY, Kim SH, Lee HJ. Utilisation of combined 18F-FDG PET/CT scan for differential diagnosis between benign and malignant adrenal enlargement. Br J Radiol. 2013 Aug;86(1028):20130190.
11. Perri M, Erba P, Volterrani D, Guidoccio F, Lazzeri E, Caramella D, et al. Adrenal masses in patients with cancer: PET/CT characterization with combined CT histogram and standardized uptake value PET analysis. AJR Am J Roentgenol 2011;197:209–16.
12. Cistaro A, Niccoli Asabella A, Coppolino P, Quartuccio N, Altini C, Cucinotta M et al. Diagnostic and prognostic value of 18F-FDG PET/CT in comparison with morphological imaging in primary adrenal gland malignancies - a multicenter experience. Hell J Nucl Med. 2015 May-Aug;18(2):97-102.
13. Wu Q, Luo W, Zhao Y, Xu F, Zhou Q. The utility of 18F-FDG PET/CT for the diagnosis of adrenal metastasis in lung cancer: a PRISMA-compliant meta-analysis. Nucl Med Commun. 2017 Dec;38(12):1117-1124.
14. Delivanis DA, Bancos I, Atwell TD Schmit GD, Eiken PW, Natt N, et al. Diagnostic performance of unenhanced computed tomography and 18 F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours. Clin Endocrinol 2018 Jan;88(1):30-36.
15. Vikram R, Yeung HD, Macapinlac HA, Iyer RB. Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer. AJR Am J Roentgenol. 2008 Nov;191(5):1545-51.
16. Okada M, Shimono T, Komeya Y. Adrenal masses: the value of additional fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in differentiating between benign and malignant lesions. Ann Nucl Med. 2009;23(4):349‐54.
17. Guaraldi F, Salvatori R. Cushing syndrome: maybe not so uncommon of an endocrine disease. J Am Board Fam Med 2012;25: 199–208.
18. Ganguly A (1998) Primary aldosteronism. N Engl J Med 339:1828–1834
19. Sung YM, Lee KS, Kim BT, Choi JY, Chung MJ, Shim YM, Chin AY, Kim TS. 18F-FDG PET versus 18F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients. Korean Journal of Radiology. 2008 Feb 1;9(1):19-28.
20. Metser U, Miller E, Lerman H, Lievshitz G, Avital S, Even-Sapir E. 18F-FDG PET/CT in the evaluation of adrenal masses. Journal of Nuclear Medicine. 2006 Jan 1;47(1):32-7.
21. Kim SJ, Lee SW, Pak K, Kim IJ, Kim K. Diagnostic accuracy of 18F-FDG PET or PET/CT for the characterization of adrenal masses: a systematic review and meta-analysis. The British journal of radiology. 2018 Jun;91(1086):20170520.
22. Wahl RL, Hicks RJ. PET Diagnosis and Response Monitoring in Oncology. InMolecular Imaging 2021 Jan 1 (pp. 1049-1076). Academic Press.
23. Kim SJ, Lee SW, Pak K, Kim IJ, Kim K. Diagnostic accuracy of 18F-FDG PET or PET/CT for the characterization of adrenal masses: a systematic review and meta-analysis. Br J Radiol. 2018 Jun;91(1086):20170520.
24. Vikram R, Yeung HD, Macapinlac HA, Iyer RB. Utility of PET/CT in differentiating benign from malignant adrenal nodules in patients with cancer. AJR Am J Roentgenol. 2008 Nov;191(5):1545-51.
25. He X., Caoili E.M., Avram A.M., Miller B.S., Else T. F-FDG-PET/CT Evaluation of Indeterminate Adrenal Masses in Noncancer Patients. J Clin Endocrinol Metab 2021;106:22-33.
26. Okada M, Shimono T, Komeya Y. Adrenal masses: the value of additional fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in differentiating between benign and malignant lesions. Ann Nucl Med. 2009;23(4):349‐54