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The aim of the present meta-analysis was to systematically evaluate the overall diagnostic accuracy of 18F-FDG PET/CT for the detection of adrenal metastasis in lung cancer.A comprehensive literature search of Medline (PubMed), Embase, Web of Science, Cochrane, and China National Knowledge Infrastructure databases published through 10 January 2017 on the role of 18F-FDG PET/CT in evaluating adrenal mass in lung cancer patients was performed. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 18F-FDG PET/CT on a per lesion-based analysis were calculated. The area under the curve was calculated to measure the accuracy of 18F-FDG PET/CT.A total of nine studies, involving 707 lung cancer patients with 810 adrenal masses, were included in the present meta-analysis. Of 810 adrenal masses from lung cancer, 411 (50.7%) and 399 (49.3%) masses were benign and metastatic, respectively. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 18F-FDG PET/CT were 0.887 [95% confidence interval (CI): 0.852–0.917], 0.908 (95% CI: 0.875–0.934), 8.552 (95% CI: 6.197–11.802), 0.090 (95% CI: 0.039–0.211), and 96.825 (95% CI: 40.402–232.05), respectively. In addition, the area under the curve was 0.9622 and the overall diagnostic accuracy (Q* index) was 0.9077, suggesting excellent performance.18F-FDG PET/CT plays a vital role in the differentiation of adrenal metastasis from a benign adrenal mass in lung cancer patients, with excellent diagnostic performance.