RESUMO
Fundamento y objetivo: Valorar la utilidad de la 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET, «tomografía de emisión de positrones con 18F-fluorodesoxiglucosa») en la caracterización prequirúrgica de masas suprarrenales, en pacientes no oncológicos, cuyas características en TAC y/o RMN fueran inespecíficas o que presentaran alguna característica de malignidad. Pacientes y métodos: Estudio transversal y prospectivo en 12 pacientes con masa suprarrenal radiológicamente inespecífica o sospechosa de malignidad que iban a ser adrenalectomizados. Se realizó una 18F-FDG-PET calculándose la captación cuantitativa máxima de FDG (SUVmáx) en adrenal (SUVmáx adrenal) e hígado (SUVmáx hígado) y el cociente SUVmáx adrenal/hígado, que se relacionaron con el resultado anatomopatológico, evaluándose la fiabilidad de la prueba mediante receive operating curves (ROC, «curvas de rendimiento diagnóstico»). Resultados: Las curvas ROC para discriminar entre lesiones benignas y malignas mostraron que el SUVmáx era mejor parámetro que el tamaño o el cociente entre SUVmáx adrenal/hígado. Utilizando como punto de corte un valor de SUVmáx ≥ 3,1 los valores de sensibilidad, especificidad, valor predictivo positivo y negativo de la prueba fueron 100, 67, 50 y 100%, respectivamente, mientras que un cociente SUVmáx adrenal/hígado ≥ 1,8 mostró una sensibilidad, una especificidad, un valor predictivo positivo y un valor predictivo negativo de 67, 100, 100 y 90%, respectivamente. La presencia de un cociente SUVmáx adrenal/hígado ≥ 1,8 mostró una asociación estadísticamente significativa con la aparición de carcinoma. Conclusión: La 18F-FDG-PET puede ser de utilidad en la caracterización de masas suprarrenales inespecíficas o sospechosas, descubiertas en pacientes no oncológicos. Su uso en algunos casos podría evitar intervenciones innecesarias (AU)
Background and objective: Our purpose was to assess the utility of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in pre-surgical characterization of adrenal masses. These masses were incidentally discovered in non-oncologic patients or during the study of endocrine hormone overproduction. These nodular lesions showed nonspecific or suspicious radiological features in the imaging tests routinely performed (CT and/or MRI). Patients and methods: This is a cross-sectional and prospective study in 12 patients with adrenal masses which were radiologically non-specific or suspicious for malignancy before adrenalectomy. An 18F-FDG-PET was made and quantitative FDG uptake (SUVmax) in the adrenal region (adrenal SUVmax) and liver (liver SUVmax), and the ratio SUVmax adrenal/liver was calculated. These parameters were related to the pathological findings. We evaluated the accuracy of the test by receive operating curves (ROC). Results: The ROC to discriminate between benign and malignant lesions showed that the SUVmax was a better parameter than size or SUVmax adrenal/liver ratio. Using a SUVmax cutoff value ≥ 3.1, sensitivity, specificity, positive and negative predictive value of the test were 100, 67, 50 and 100%, while a SUVmax adrenal/liver ratio ≥ 1.8 showed a sensitivity, specificity, positive and negative predictive value of 67, 100, 100 and 90%, respectively. The presence of a SUVmax adrenal/liver ratio ≥ 1.8 showed a statistically significant association with carcinoma occurrence. Conclusion: 18F-FDG-PET may be useful in the characterization of nonspecific or suspicious adrenal masses discovered in patients without a previous history of cancer. Its use in some cases could avoid unnecessary interventions (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais , Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18 , Sensibilidade e Especificidade , Estudos Transversais/métodos , Estudos Prospectivos , Córtex Suprarrenal/fisiopatologia , Córtex Suprarrenal , Neoplasias das Glândulas Suprarrenais , Curva ROC , Valor Preditivo dos TestesRESUMO
BACKGROUND AND OBJECTIVE: Our purpose was to assess the utility of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in pre-surgical characterization of adrenal masses. These masses were incidentally discovered in non-oncologic patients or during the study of endocrine hormone overproduction. These nodular lesions showed nonspecific or suspicious radiological features in the imaging tests routinely performed (CT and/or MRI). PATIENTS AND METHODS: This is a cross-sectional and prospective study in 12 patients with adrenal masses which were radiologically non-specific or suspicious for malignancy before adrenalectomy. An 18F-FDG-PET was made and quantitative FDG uptake (SUVmax) in the adrenal region (adrenal SUVmax) and liver (liver SUVmax), and the ratio SUVmax adrenal/liver was calculated. These parameters were related to the pathological findings. We evaluated the accuracy of the test by receive operating curves (ROC). RESULTS: The ROC to discriminate between benign and malignant lesions showed that the SUVmax was a better parameter than size or SUVmax adrenal/liver ratio. Using a SUVmax cutoff value≥3.1, sensitivity, specificity, positive and negative predictive value of the test were 100, 67, 50 and 100%, while a SUVmax adrenal/liver ratio≥1.8 showed a sensitivity, specificity, positive and negative predictive value of 67, 100, 100 and 90%, respectively. The presence of a SUVmax adrenal/liver ratio≥1.8 showed a statistically significant association with carcinoma occurrence. CONCLUSION: 18F-FDG-PET may be useful in the characterization of nonspecific or suspicious adrenal masses discovered in patients without a previous history of cancer. Its use in some cases could avoid unnecessary interventions.
