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CT) in the evaluation of the metastatic adrenal masses
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Role of Positron Emission Tomography/Computed Tomography (PET/CT) in the evaluation of the metastatic adrenal masses Eur Urol Suppl 2014;13;e394
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Kaygisiz O., Ozmerdiven G., Kordan Y., Coskun B., Vuruskan H., Yavascaoglu I. Bursa Uludag University Medical School, Dept. of Urology, Bursa, Turkey INTRODUCTION & OBJECTIVES: To investigate the role of PET/CT imaging in the diagnosis of the patients with suspected metastases in the adrenal gland. MATERIAL & METHODS: Forty-one patients with suspected metastases out of the 178 patients that Laparoscopic Adrenalectomy was performed in our clinic between March 2004 and July 2013. Fourteen patients without PET imaging were excluded from the study. Of the remaining 27 patients, the primary tumors in 22 were non small cell lung cancer (NSCLC). The parameters of the patients and peak standardized uptake values (SUVmax) were compared between the groups with benign and malignant pathologies. RESULTS: Malignancies were found in none of the six patients that primary malignancies were non-NSCLC. The mean adrenal SUV max value of these patients was 4.7 (3-10). Three patients out of 23 with NCLC as the primary malignancies were females. Metastases were found in 17 adrenal masses (74%). The ages of the patients were smaller in the group without metastases (table). Sex of the patient, subtype of the lung cancer and the size of the adrenal mass were ineffective for the prediction of the metastasis (table). Together with this, the SUVmax value was found as significantly higher in the metastatic group (table ). If the threshold value of SUV max for metastatic were taken as 3, sensitivity would be 100% and specificity would be 50%; whereas if the same value were taken as 4 or 5, sensitivity would be 88.2% and 76.5, respectively, and specificity would be 82.4% and 100%, respectively. CT or MRI images taken in 22 were ineffective in determining the metastases (p=0,179) (table 2). Specificity was 83.3%, while sensitivity was only 60%. However, in case we accepted the presence of suspicious metastasis based on CT or MRI as the criterion in the group we took the SUV max threshold value as 4, one patient more would be diagnosed to increase sensitivity to 94.11% and to decrease specificity to 66%. Likewise, taking the threshold SUV max value as 5 would allow diagnosing of 2 more patients and diagnosis of only 1 patient would be missed increasing sensitivity to 94.1% and lowering specificity to 83.3%.
Benign Metastasis Grup 1 (n=6) (Grup 2) (n=17) P
Age (year)a
64,3±7,4
56,2± 7,8
0,047
SUVmax a
2,8± 1,3
9,3±4,9
<0,001
Adrenal mass diameter (mm) a
26,0± 9,5
29± 15,5
0,617
male
4
16 (80%)
female
2
1 (33,3%)
Squamoz
3
7 (70%)
Adenocancer
3
10 (76,9%)
benign
5
6
metastasis
1
9
≤3
3
0 (0%)
Gender
Lung cancer subtypes
CT/MRI
SUV maxb
0,155
0,708
0,149
0,011
SUV maxb
SUV maxb
SUVmax/ MRI-CT
SUVmax/ MRI-CT
>3
3
17 (85%)
≤4
5
2 (28,6%)
>4
1
15(93,8%)
≤5
6
3 (33,3%)
>5
0
14 (100%)
≤4, benign
4
1 (20%)
> 4, metastasis 2
16 (88,9%)
≤5, benign
1 (16,7%)
5
> 5, metastasis 1
16 (94,1%)
0,003 0,001 0,008
0,001
Table: Comparison of the patients with primary NSCLC tumors in groups with and without metastasis ( a : parametric data, b : nominal data, p<0.05; statistical significance) CONCLUSIONS: In our series, PET/CT appears as an effective imaging modality to determine the adrenal metastases in patients with NSCLC as the primary disease. Follow-up may be considered in the first place for patients with SUV max values smaller than 3. SUVmax threshold value 5 sensitivity can be increased by combining with CT or MRI. PET/BT appears to be in adequate for the prediction of nonNSCLC metastasis, although our patients with non-NSCLC primary tumors were insufficient.
Role of Positron Emission Tomography/Computed Tomography (PET/CT) in the evaluation of the metastatic adrenal masses Eur Urol Suppl 2014;13;e394
Print! Print!
Kaygisiz O., Ozmerdiven G., Kordan Y., Coskun B., Vuruskan H., Yavascaoglu I. Bursa Uludag University Medical School, Dept. of Urology, Bursa, Turkey INTRODUCTION & OBJECTIVES: To investigate the role of PET/CT imaging in the diagnosis of the patients with suspected metastases in the adrenal gland. MATERIAL & METHODS: Forty-one patients with suspected metastases out of the 178 patients that Laparoscopic Adrenalectomy was performed in our clinic between March 2004 and July 2013. Fourteen patients without PET imaging were excluded from the study. Of the remaining 27 patients, the primary tumors in 22 were non small cell lung cancer (NSCLC). The parameters of the patients and peak standardized uptake values (SUVmax) were compared between the groups with benign and malignant pathologies. RESULTS: Malignancies were found in none of the six patients that primary malignancies were non-NSCLC. The mean adrenal SUV max value of these patients was 4.7 (3-10). Three patients out of 23 with NCLC as the primary malignancies were females. Metastases were found in 17 adrenal masses (74%). The ages of the patients were smaller in the group without metastases (table). Sex of the patient, subtype of the lung cancer and the size of the adrenal mass were ineffective for the prediction of the metastasis (table). Together with this, the SUVmax value was found as significantly higher in the metastatic group (table ). If the threshold value of SUV max for metastatic were taken as 3, sensitivity would be 100% and specificity would be 50%; whereas if the same value were taken as 4 or 5, sensitivity would be 88.2% and 76.5, respectively, and specificity would be 82.4% and 100%, respectively. CT or MRI images taken in 22 were ineffective in determining the metastases (p=0,179) (table 2). Specificity was 83.3%, while sensitivity was only 60%. However, in case we accepted the presence of suspicious metastasis based on CT or MRI as the criterion in the group we took the SUV max threshold value as 4, one patient more would be diagnosed to increase sensitivity to 94.11% and to decrease specificity to 66%. Likewise, taking the threshold SUV max value as 5 would allow diagnosing of 2 more patients and diagnosis of only 1 patient would be missed increasing sensitivity to 94.1% and lowering specificity to 83.3%.
Benign Metastasis Grup 1 (n=6) (Grup 2) (n=17) P
Age (year)a
64,3±7,4
56,2± 7,8
0,047
SUVmax a
2,8± 1,3
9,3±4,9
<0,001
Adrenal mass diameter (mm) a
26,0± 9,5
29± 15,5
0,617
male
4
16 (80%)
female
2
1 (33,3%)
Squamoz
3
7 (70%)
Adenocancer
3
10 (76,9%)
benign
5
6
metastasis
1
9
≤3
3
0 (0%)
Gender
Lung cancer subtypes
CT/MRI
SUV maxb
0,155
0,708
0,149
0,011
SUV maxb
SUV maxb
SUVmax/ MRI-CT
SUVmax/ MRI-CT
>3
3
17 (85%)
≤4
5
2 (28,6%)
>4
1
15(93,8%)
≤5
6
3 (33,3%)
>5
0
14 (100%)
≤4, benign
4
1 (20%)
> 4, metastasis 2
16 (88,9%)
≤5, benign
1 (16,7%)
5
> 5, metastasis 1
16 (94,1%)
0,003 0,001 0,008
0,001
Table: Comparison of the patients with primary NSCLC tumors in groups with and without metastasis ( a : parametric data, b : nominal data, p<0.05; statistical significance) CONCLUSIONS: In our series, PET/CT appears as an effective imaging modality to determine the adrenal metastases in patients with NSCLC as the primary disease. Follow-up may be considered in the first place for patients with SUV max values smaller than 3. SUVmax threshold value 5 sensitivity can be increased by combining with CT or MRI. PET/BT appears to be in adequate for the prediction of nonNSCLC metastasis, although our patients with non-NSCLC primary tumors were insufficient.