Adrenocortical cancer (ACC) is an uncommon primary neoplasm of the adrenal cortex with dismal prognosis. It often presents with symptoms and signs of adrenal cortical hormone hypersecretion and abdominal mass effect or is incidentally detected as an adrenal mass on imaging performed for other indications.
Endocrine evaluation, comprehensive staging, and meticulous resection are crucial to ensure the best possible outcome. Despite extensive initial surgical resection, local and distant metastases are not uncommon with disappointing 5-year survival, although progress is being made at high-volume centers. Accurate restaging of recurrent disease is important to guide further management. Mitotane, external beam radiation and chemotherapy, and newer anticancer systemic treatments are used as adjunctives for inoperable disease and distant metastases. Contrast-enhanced CT and MRI are first-line imaging modalities for evaluation of ACC to characterize adrenal masses and to determine tumor resectability. Emerging literature supports F-FDG PET/CT use to determine the malignant potential of adrenal masses. In patients with a diagnosis of ACC, FDG PET/CT is sensitive for detecting metastatic disease, and its tumor accumulation has been correlated to pathology, Weiss scores, and prognosis. Metomidate, labeled with C for PET or with I for SPECT/CT, allows characterization of an adrenal mass as being of adrenocortical origin with high specificity. Taking advantage of its adrenocortical avidity, metomidate has been labeled with I for radionuclide therapy in a subset of ACC. In this review, we describe how nuclear medicine imaging, and specifically PET, can assist surgical management of ACC.
Clinical nuclear medicine. 2016 Jan 28 [Epub ahead of print]
Ka Kit Wong, Barbra S Miller, Benjamin L Viglianti, Ben A Dwamena, Paul G Gauger, Gary J Cook, Patrick M Colletti, Domenico Rubello, Milton D Gross
From the *Nuclear Medicine/Radiology Department, University of Michigan Hospital; †Nuclear Medicine Service, Department of Veterans Affairs Health System; ‡Endocrine Surgery/General Surgery Department, University of Michigan Hospital; and §Radiology Service, Department of Veterans Affairs Health System, Ann Arbor, MI; ∥Division of Imaging Sciences and Biomedical Engineering, Department of Cancer Imaging, King's College London, St Thomas' Hospital, London, United Kingdom; ¶Department of Radiology, University of Southern California, Los Angeles, CA; and **Department of Nuclear Medicine, Radiology, NeuroRadiology, Medical Physics, Laboratory, Microbiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.