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ContextThe role of 18F-labeled 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the post-operative monitoring of patients with adrenocortical carcinoma (ACC) is still unclear.ObjectiveTo assess the accuracy of FDG PET/CT to diagnose ACC recurrence in a real world setting.Design and methodsRetrospective evaluation of data of 57 patients with presumed ACC recurrence at CT scan who underwent FDG PET/CT within a median time of 20 days. We compared the results of either FDG PET/CT or CT with a gold standard confirmation of recurrence (positive histopathology report of removed/biopsied lesions or radiological progression of target lesions at follow-up) to assess their diagnostic performance at different body sites to correctly categorize target lesions. We also assessed whether FDG PET/CT findings may be useful to inform the management strategy.ResultsIn 48 patients with confirmed ACC recurrence, we found that FDG PET/CT had lower sensitivity than CT in diagnosing liver and lung recurrences of ACC. FDG PET/CT had higher specificity than CT in categorizing liver lesions. FDG PET/CT had a greater positive likelihood ratio than CT to identify liver and abdominal ACC recurrences. The management strategy was changed based on FDG PET/CT findings in 12 patients (21.1%).ConclusionsThe greater sensitivity of CT may be partly expected due the specific inclusion criteria of the study; however, the greater specificity of FDG PET/CT was particularly useful in ruling out suspected ACC recurrences found by CT. Thus, use of FDG PET/CT as a second-line test in the post-operative surveillance of ACC patients following CT finding of a potential recurrence may have a significant impact on patient management.

Bones/other 6 1 49 1 6 1 49 1 Comparison between PET-CT and CT in the diagnosis of recurrence of adrenocortical carcinoma. C. Massaglia1, A. Ardito1, B. Zaggia1, V. Basile1, F. Daffara1, E. Pelosi2, V. Arena2, D. Penna2, M. Terzolo1 1 Internal Medicine I, San Luigi Gonzaga Hospital, University of Turin; 2 IRMET PET-CT Diagnostic Imaging Center, Turin; Italy. BACKGROUND Adrenocortical carcinoma (ACC) is a rare tumor characterized by a high rate of recurrence even after radical surgery. Surgery of recurrent ACC may increase survival; thus, it is mandatory a timely detection of recurrence and an accurate assessment of disease burden, either to increase the chance of radical extirpation or to avoid unnecessary surgery.