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. 2020 Jul-Sep;16(3):316-323.
doi: 10.4183/aeb.2020.316.

THE ROLE OF TUMOR-SEEKING RADIOPHARMACEUTICALS IN THE DIAGNOSIS AND MANAGEMENT OF ADRENAL TUMORS

V Vukomanovic  1   2 , M Matovic  1 , A Djukic  1   3 , V Ignjatovic  1   2 , K Vuleta  1 , S Djukic  4 , I Simic Vukomanovic  5
Affiliations

THE ROLE OF TUMOR-SEEKING RADIOPHARMACEUTICALS IN THE DIAGNOSIS AND MANAGEMENT OF ADRENAL TUMORS

V Vukomanovic et al. Acta Endocrinol (Buchar). 2020 Jul-Sep.

Abstract

Context: The variety of tumor-seeking radiopharmaceuticals, which are currently in clinical use, may have a potential role as imaging agents for adrenal gland tumors, due to physiological characteristics of this organ.

Objective: The purpose of this study was to evaluate the diagnostic potential of 99mTc-HYNIC-TOC, 99mTc(V)-DMSA, and 99mTc-MIBI in the assessment of adrenal tumors, by correlating with imaging findings and histopathologic results.

Design: The research is designed as a cross-sectional prospective study.

Patients and method: The study included 50 patients with adrenal tumors (19 hormone-secreting and 31 nonfunctioning) and 23 controls without adrenal involvement. In all patients, single-photon emission computed tomography (SPECT) was performed, using qualitative and semiquantitative analysis. The tumor to non-tumor tracer uptake was conducted by using a region-of-interest technique. Adrenal to background (A/B) ratio was calculated in all cases.

Results: 99mTc-HYNIC-TOC scintigraphy showed a high statistical significance between A/B ratios, while other two tracers resulted in a lower sensitivity, specificity and accuracy. Futhermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumors (the receiver-operating-characteristic curve analysis, A/B ratio cut-off value of 8.40).

Conclusion: A semiquantitative SPECT analysis showed that 99mTc-HYNIC-TOC is a highly sensitive tumor-seeking agent for the accurate localization of adrenal tumors.

Keywords: 99mTc(V)-DMSA; 99mTc-HYNIC-TOC; 99mTc-MIBI; adrenal tumor; scintigraphy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
A transaxial (1) contrast-enhanced CT image shows a 30 mm homogeneous circumscribed well delineated tumor in the right adrenal; (2) 99mTc-HYNIC-TOC SPECT image with a focal somatostatin-avid tracer uptake in the right adrenal mass, which was confirmed as a lipid-poor adenoma.
Figure 2.
Figure 2.
Transverse, sagittal and coronal slices of the acquired SPECT, post processing using iterative reconstruction OSEM method. A ROI was drawn on transversal image around the tumor (red circle) while a mirror ROI was drawn above background tissue (blue circle).
Figure 3.
Figure 3.
Distribution of adrenal/background ratios in the 3 studied groups revealing a statistically significant difference (t-test for independent samples*) only with 99mTc-HYNIC-TOC SPECT between adrenal tumors (n=50) and the control group (n=23).
Figure 4.
Figure 4.
Receiver-operating-characteristic curve (ROC) for 99mTc-HYNIC-TOC SPECT uptake values. This curve was constructed from A/B ratios of adrenal tumors lesions and of normal adrenals.
See this image and copyright information in PMC

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