Ilias I, Meristoudis G. Changing paradigms in evaluating adrenal incidentalomas: Bayesian evaluation of [18F]Fluorodeoxyglucose positron emission tomography use, honed on adrenocortical carcinoma. World J Clin Oncol 2025; 16(6): 106511 [DOI: 10.5306/wjco.v16.i6.106511]
Corresponding Author of This Article
Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, 63, Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Jun 24, 2025; 16(6): 106511 Published online Jun 24, 2025. doi: 10.5306/wjco.v16.i6.106511
Changing paradigms in evaluating adrenal incidentalomas: Bayesian evaluation of [18F]Fluorodeoxyglucose positron emission tomography use, honed on adrenocortical carcinoma
Ioannis Ilias, Georgios Meristoudis
Ioannis Ilias, Department of Endocrinology, Hippocration General Hospital, Athens GR-11527, Greece
Georgios Meristoudis, Department of Nuclear Medicine, Hippokration General Hospital, Thessaloniki 54643, Greece
Author contributions: Ilias I and Meristoudis G conceived, performed the literature search and wrote this paper; Both authors agree to this paper's submission.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, 63, Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com
Received: February 28, 2025 Revised: March 20, 2025 Accepted: April 25, 2025 Published online: June 24, 2025 Processing time: 112 Days and 16 Hours
Abstract
We present the diagnostic performance of [18F]Fluorodeoxyglucose positron emission tomography (FDG PET) for adrenal incidentalomas based on lesion size and unenhanced computed tomography (CT) density in Hounsfield units (HU), following current literature and guidelines. A 20 HU cutoff can be applied to differentiate potentially benign from malignant lesions, particularly in ruling in or out adrenocortical carcinoma. While FDG PET provides valuable metabolic information, its likelihood ratios for a positive (LR+) or negative (LR-) result do not exceed the robust diagnostic thresholds of > 10.0 or < 0.1, respectively. This suggests that positron emission tomography alone is insufficient for definitive characterization and should be integrated with CT or magnetic resonance imaging to leverage their complementary anatomical and functional imaging strengths for optimal diagnostic accuracy.
Core Tip: [18F]Fluorodeoxyglucose positron emission tomography (FDG PET) diagnostic performance for adrenal incidentalomas (AdIn) was evaluated based on their size as measured on computed tomography (CT) and their unenhanced density in Hounsfield units (HU), using a 20 HU cutoff to assess adrenocortical carcinoma (ACC) risk. The likelihood ratios for positive/negative tests do not meet the usual thresholds, respectively, indicating strong but not definitive diagnostic accuracy. FDG PET should be combined with CT or magnetic resonance imaging for optimal assessment of AdIns.
