Preoperative 18F-FDG PET/CT in Pheochromocytomas and Paragangliomas Allows for Precision Surgery

Ann Surg. 2019 Apr;269(4):741-747. doi: 10.1097/SLA.0000000000002671.

Abstract

Background: Fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) imaging is recommended in patients with metastatic pheochromocytoma (PC) and paraganglioma (PGL). There are no data on whether routine preoperative F-FDG PET/CT in all patients with PC/PGL impacts surgical management.

Objective: The aim of this study was to determine whether routine preoperative F-FDG PET/CT imaging affects the surgical management of patients with PC/PGLs.

Methods: We analyzed clinical, biochemical, genetic, and anatomic imaging data in 93 consecutive patients with PC/PGL who collectively underwent a total of 100 operations and who had preoperative F-FDG PET/CT imaging.

Results: Of 100 operations, preoperative F-FDG PET/CT showed additional lesions compared to anatomic imaging in 15 cases. These patients were more likely to undergo an open surgical approach (P < 0.05). Presence of genetic mutation, redo operations, sex, age, or tumor size had no significant association with finding additional lesions on F-FDG PET/CT.

Conclusions: Additional lesions detected on preoperative F-FDG-PET/CT imaging have an impact on the surgical approach in patients with PC/PGLs. Therefore, surgeons should routinely obtain F-FDG-PET/CT imaging in patients with PC/PGL to allow for a more precise surgical intervention.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adrenal Gland Neoplasms / diagnostic imaging*
  • Adrenal Gland Neoplasms / surgery*
  • Adrenalectomy / methods*
  • Adult
  • Aged
  • Child
  • Female
  • Fluorodeoxyglucose F18 / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Paraganglioma / diagnostic imaging*
  • Paraganglioma / secondary
  • Paraganglioma / surgery*
  • Pheochromocytoma / diagnostic imaging*
  • Pheochromocytoma / secondary
  • Pheochromocytoma / surgery*
  • Positron Emission Tomography Computed Tomography*
  • Precision Medicine
  • Preoperative Care
  • Prospective Studies
  • Radiopharmaceuticals / therapeutic use*
  • Young Adult

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18