Changing paradigms in evaluating adrenal incidentalomas: Bayesian evaluation of [18F]Fluorodeoxyglucose positron emission tomography use, honed on adrenocortical carcinoma

doi:10.5306/wjco.v16.i6.106511

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World Journal of Clinical Oncology

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World J Clin Oncol. Jun 24, 2025; 16(6): 106511
Published online Jun 24, 2025. doi: 10.5306/wjco.v16.i6.106511

Changing paradigms in evaluating adrenal incidentalomas: Bayesian evaluation of [¹⁸F]Fluorodeoxyglucose positron emission tomography use, honed on adrenocortical carcinoma

Ioannis Ilias, Georgios Meristoudis

Ioannis Ilias, Department of Endocrinology, Hippocration General Hospital, Athens GR-11527, Greece

Georgios Meristoudis, Department of Nuclear Medicine, Hippokration General Hospital, Thessaloniki 54643, Greece

Author contributions: Ilias I and Meristoudis G conceived, performed the literature search and wrote this paper; Both authors agree to this paper's submission.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Corresponding author: Ioannis Ilias, MD, PhD, Director, Department of Endocrinology, Hippocration General Hospital, 63, Evrou Street, Athens GR-11527, Greece. iiliasmd@yahoo.com

Received: February 28, 2025
Revised: March 20, 2025
Accepted: April 25, 2025
Published online: June 24, 2025
Processing time: 112 Days and 22.4 Hours

Core Tip

Core Tip: [¹⁸F]Fluorodeoxyglucose positron emission tomography (FDG PET) diagnostic performance for adrenal incidentalomas (AdIn) was evaluated based on their size as measured on computed tomography (CT) and their unenhanced density in Hounsfield units (HU), using a 20 HU cutoff to assess adrenocortical carcinoma (ACC) risk. The likelihood ratios for positive/negative tests do not meet the usual thresholds, respectively, indicating strong but not definitive diagnostic accuracy. FDG PET should be combined with CT or magnetic resonance imaging for optimal assessment of AdIns.