Combined [18F]Fluorodeoxyglucose PET and [123I]Iodometomidate-SPECT for diagnostic evaluation of indeterminate adrenal neoplasias - The prospective cross-sectional diagnostic test performance study FAMIAN

Stefanie Hahner; Philipp Hartrampf; Felix Beuschlein; Matthias Miederer; Konstanze Miehle; Schlotelburg Wiebke; Carmina Teresa Fuss; Thomas Pflmger; Christian Fottner; Anke Tonjes; Ken Herrmann; Holger Amthauer; Mathias Schreckenberger; Osama Sabri; Johanna Werner; Miriam Reuter; Stefan Kircher; Wiebke Arlt; Martin Fassnacht; Andreas Buck; Hans Helge Muller; Schirbel Andreas

doi:10.1530/endoabs.99.RC3.2

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Endocrine Abstracts (2024) 99 RC3.2 | DOI: 10.1530/endoabs.99.RC3.2

ECE2024 Rapid Communications Rapid Communications 3: Adrenal and Cardiovascular Endocrinology | Part I (7 abstracts)

Combined [18F]Fluorodeoxyglucose PET and [123I]Iodometomidate-SPECT for diagnostic evaluation of indeterminate adrenal neoplasias – The prospective cross-sectional diagnostic test performance study FAMIAN

Stefanie Hahner ¹ , Philipp Hartrampf ² , Felix Beuschlein ³ , Matthias Miederer ⁴ , Konstanze Miehle ⁵ , Schlötelburg Wiebke ² , Carmina Teresa Fuss ¹ , Thomas Pflmger ⁶ , Christian Fottner ⁷ , Anke Tönjes ⁵ , Ken Herrmann ⁸ , Holger Amthauer ⁹ , Mathias Schreckenberger ⁴ , Osama Sabri ¹⁰ , Johanna Werner ¹ , Miriam Reuter ¹ , Stefan Kircher ¹¹ , Wiebke Arlt ¹² , Martin Fassnacht ¹ , Andreas Buck ² , Hans Helge Müller ¹³ & Schirbel Andreas ²

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¹University Hospital Würzburg, Division of Endocrinology and Diabetology, Würzburg; ²University Hospital Würzburg, Department of Nuclear Medicine, Würzburg; ³Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich (USZ) und Universität Zürich (UZH), Switzerland, Switzerland; ⁴Department of Nuclear Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany, Germany; ⁵University Hospital Leipzig, Medizinische Klinik und Poliklinik III – Endokrinologie, Nephrologie, Rheumatologie, Leipzig, Germany; ⁶Klinikum der Universität München, Department of Nuclear Medicine, Munich, Germany; ⁷Department of Endocrinology and Metabolism, I Medical Clinic, University Medical Center of the Johannes Gutenberg University Mainz; ⁸Department of Nuclear Medicine, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen; German Cancer Consortium (DKTK), Partner Site University Hospital Essen; ⁹Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, ¹⁰Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, ¹¹Institute of Pathology, University of Würzburg, ¹²Medical Research Council Laboratory of Medical Sciences, London, UK, ¹³Institute of Medical Bioinformatics and Biostatistics, Philipps University of Marburg

Adrenal tumours are frequently detected by conventional cross-sectional imaging, which, however, has limited specificity in identifying the most prevalent tumour type, benign, non-functional adrenocortical adenomas (ACA) not requiring surgery. We assessed the diagnostic accuracy of adrenal molecular imaging with [¹⁸F]Fluorodeoxyglucose-positron emission tomography (FDG-PET) and [^123I]Iodometomidate-single photon emission tomography (IMTO-SPECT). We performed a prospective, multicentre study in adult patients (≥30 years) with indeterminate adrenal masses (diameter >3 cm and unenhanced computed tomography [CT] tumour attenuation ≥10 Hounsfield units [HU]). We assessed the diagnostic performance of combined FDG/IMTO imaging in detecting ACA, using a reference standard of histopathology. Low FDG uptake (=FDG-negative) with high IMTO uptake (=IMTO-positive) was considered indicative of ACA. We also assessed the utility of FDG and unenhanced CT tumour attenuation in detecting malignancy. Between July 2015 and December 2020, 85 patients were enrolled and 77 included in the final analysis; 53 harboured benign and 24 malignant adrenal masses. Combined FDG/IMTO-imaging identified ACA with high specificity (95·7% [95%CI 85·2-99·5%]; positive predictive value 87·5% [95%CI 61·7-98·5%]; positive likelihood ratio 11·1 [95%CI 3·2-122·2%]). However, sensitivity was low (48·3% [95%CI 29·4-67·5%]) due to moderate or high FDG uptake in 14 of 30 ACAs. Malignant masses were identified with high sensitivity but low specificity both by unenhanced CT (cut-off HU≥20 sensitivity 100% [95%CI 85·8-100%], specificity 26·4% [95%CI 15·3-40·3%]) and FDG (sensitivity 95·8% [95%CI 78·9-99·9%], specificity 62·3% [95%CI 47·9-75·2%]). Combined FDG/IMTO-imaging identifies ACA with high specificity in this cohort with indeterminate masses. However, the presence of a sub-cohort of FDG-positive ACA decreases sensitivity.