Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size

Adrenal incidentalomas (AIs) are masses > 1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, qu...

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Bibliographic Details
Published in:	BMC urology Vol. 22; no. 1; p. 73
Main Authors:	Zekan, David, King, Robert Scott, Hajiran, Ali, Patel, Apexa, Deem, Samuel, Luchey, Adam
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 30-04-2022 BioMed Central BMC
Subjects:	Adenoma Adrenal Cortex Neoplasms - diagnosis Adrenal Gland Neoplasms - pathology Adrenal glands Adrenalectomy Adrenocortical carcinoma Adrenocortical Carcinoma - surgery Age Biopsy Computed tomography Cross-sectional imaging CT imaging Data analysis Diagnostic imaging Histology Humans Magnetic resonance imaging Malignancy Medical imaging Medical imaging equipment Metastasis MRI Nephrectomy Neuroendocrine tumors Pathology Patients Retrospective Studies Review boards Tumors Ultrasonic imaging Urology West Virginia United States > US CT Malignancy Cross-sectional imaging MRI Adrenocortical carcinoma
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Summary:	Adrenal incidentalomas (AIs) are masses > 1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses. 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, < 18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher's exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression. 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured > 6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p = 0.008 and 0.011). Our results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-2490 1471-2490
DOI:	10.1186/s12894-022-01024-5