ACR Appropriateness Criteria® Staging and Follow-Up of Adrenal Cancer

Primary adrenal gland malignancies include adrenocortical carcinoma (ACC) and pheochromocytoma. For initial staging and restaging or surveillance of known or suspected ACC, MRI of the abdomen and pelvis without and with contrast, CT of the abdomen and pelvis with contrast, CT of the chest with contrast, and fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT, or FDG-PET/MRI are recommended to assess for local extent and distant metastases or to evaluate for recurrence. For initial staging and restaging or surveillance of known or suspected pheochromocytoma, MRI of the abdomen and pelvis without and with contrast, CT of the abdomen and pelvis with contrast, CT of the chest with contrast, DOTATATE PET/CT, or DOTATATE PET/MRI are recommended to assess local extent and distant metastases or to evaluate for recurrence. Meta-iodobenzylguanidine (MIBG) scan whole body with single-photon emission CT (SPECT) or SPECT/CT area of interest is an acceptable alternative for initial staging of known or suspected pheochromocytoma, in particular to determine eligibility for I-131 MIBG therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.