Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen 9713GZ, Netherlands.
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen 9713GZ, Netherlands.
J Clin Endocrinol Metab. 2023 Aug 18;108(9):2435-2445. doi: 10.1210/clinem/dgad138.
Imaging plays an important role in the characterization of adrenal tumors, but findings might be inconclusive. The clinical question is whether 18F fluodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is of diagnostic value in this setting.
This meta-analysis was aimed at the diagnostic value of 18F-FDG PET/CT in differentiating benign from malignant adrenal tumors discovered either as adrenal incidentaloma or during staging or follow-up of oncologic patients.
PubMed, EMBASE, Web of Science, and Cochrane Library were searched to select articles between 2000 and 2021.
We included studies describing the diagnostic value of 18F-FDG PET/CT in adult patients with an adrenal tumor. Exclusion criteria were 10 or fewer participants, insufficient data on histopathology, clinical follow-up, or PET results. After screening of title and abstract by 2 independent reviewers, 79 studies were retrieved, of which 17 studies met the selection criteria.
Data extraction using a protocol and quality assessment according to QUADAS-2 was performed independently by at least 2 authors.
A bivariate random-effects model was applied using R (version 3.6.2.). Pooled sensitivity and specificity of 18F-FDG PET/CT for identifying malignant adrenal tumors was 87.3% (95% CI, 82.5%-90.9%) and 84.7% (95% CI, 79.3%-88.9%), respectively. The pooled diagnostic odds ratio was 9.20 (95% CI, 5.27-16.08; P < .01). Major sources of heterogeneity (I2, 57.1% [95% CI, 27.5%-74.6%]) were in population characteristics, reference standard, and interpretation criteria of imaging results.
18F-FDG PET/CT had good diagnostic accuracy for characterization of adrenal tumors. The literature, however, is limited, in particular regarding adrenal incidentalomas. Large prospective studies in well-defined patient populations with application of validated cutoff values are needed.
影像学在肾上腺肿瘤的特征描述中起着重要作用，但结果可能不确定。临床问题是氟脱氧葡萄糖 18F（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在这种情况下是否具有诊断价值。
本荟萃分析旨在评估 18F-FDG PET/CT 在鉴别诊断偶然发现的或在肿瘤患者分期或随访过程中发现的良性和恶性肾上腺肿瘤方面的诊断价值。
检索了 2000 年至 2021 年期间的 PubMed、EMBASE、Web of Science 和 Cochrane Library 中的文章，以选择描述 18F-FDG PET/CT 在患有肾上腺肿瘤的成年患者中的诊断价值的文章。排除标准为参与者人数为 10 人或更少，或组织病理学、临床随访或 PET 结果的数据不足。两名独立审查员对标题和摘要进行筛选后，检索到 79 篇研究，其中 17 篇符合选择标准。
使用协议和根据 QUADAS-2 进行的质量评估独立地由至少两名作者进行数据提取。
使用 R（版本 3.6.2）应用双变量随机效应模型。18F-FDG PET/CT 用于识别恶性肾上腺肿瘤的汇总敏感性和特异性分别为 87.3%（95%CI，82.5%-90.9%）和 84.7%（95%CI，79.3%-88.9%）。汇总诊断优势比为 9.20（95%CI，5.27-16.08；P<.01）。异质性的主要来源（I2，57.1%[95%CI，27.5%-74.6%]）为人群特征、参考标准和影像学结果的解释标准。
18F-FDG PET/CT 对肾上腺肿瘤的特征描述具有良好的诊断准确性。然而，文献，特别是关于偶然发现的肾上腺肿瘤的文献有限。需要在明确界定的患者人群中进行大型前瞻性研究，并应用验证的临界值。
