Incidental Adrenal Nodules in Patients Without Known Malignancy: Prevalence of Malignancy and Utility of Washout CT for Characterization—A Multiinstitutional Study

Corwin, Michael T.; Badawy, Mohamed; Caoili, Elaine M.; Carney, Benjamin; Çolak, Ceylan; Elsayes, Khaled M.; Gerson, Rosalind; Klimkowski, Sergio; McPhedran, Rachel; Pandya, Amit G.; Pouw, Matthew; Schieda, Nicola; Song, Junhui; Remer, Erick M.

doi:10.2214/ajr.22.27901

Cited by 24 publications

(8 citation statements)

References 32 publications

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“…Post-contrast phases of CT examination are very important for further dynamic evaluation of adrenal masses. Venous phase (60 s) according to studies does not provide any important element for differential diagnosis, when comparing adenomas and non-adenomas, showing a significant enhancement, with substantially overlapped density values [28,[30][31][32][33]. In our study, in the venous phase, we obtained similar results, between non-functional (85.97 HU, SD 27.66) and secretory adenoma (84.47 HU, SD 24.51) with no statistically significant difference (p = 0.960).…”

Section: Discussionmentioning

confidence: 99%

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Kocic,

Vukomanovic,

Djukic

et al. 2023

Medicina

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Background and Objectives: Primary adrenal tumors (AT) are a heterogeneous group of neoplasms due to their functional heterogeneity, which results in the diverse clinical presentation of these tumors. The purpose of this study was to examine cross-sectional imaging characteristics using multi-detector computed tomography (MDCT) to provide insight into the lesion characterization and functional status of these tumors. The radionuclide imaging using Technetium-99m radiolabeled hydrazinonicotinylacid-d-phenylalanyl1-tyrosine3-octreotide (99mTc-HYNIC-TOC), was also used in the diagnostic evaluation of these tumors. Materials and Methods: This cross-sectional study included 50 patients with confirmed diagnoses of AT (21 hormone-secreting and 29 non-functional) at the University Clinical Center, Kragujevac, Serbia, during the 2019–2022 year period. The morphological and dynamic characteristics using MDCT were performed, using qualitative, semi-quantitative, and quantitative analysis. Absolute washout (APW) and relative washout (RPW) values were also calculated. A semi-quantitative analysis of all visual findings with 99mTc-HYNIC-TOC was performed to compare the tumor to non-tumor tracer uptake. Results: A statistically significant difference was found in the MDCT values in the native phase (p < 0.05), the venous phase (p < 0.05), and the delayed phase (p < 0.001) to detect the existence of adrenal tumors. Most of these functional adrenocortical lesions (n = 44) can be differentiated using the delayed phase (p < 0.05), absolute percentage washout (APW) (p < 0.05), and relative percentage washout (RPW) (p < 0.001). Furthermore, 99mTc-HYNIC-TOC could have a high diagnostic yield to detect adrenal tumor existence (p < 0.001). There is a positive correlation between radionuclide imaging scan and APW to detect all AT (p < 0.01) and adrenocortical adenomas as well (p < 0.01). Conclusions: The results can be very helpful in a diagnostic algorithm to quickly and precisely diagnose the expansive processes of the adrenal glands, as well as to learn about the advantages and limitations of the mentioned imaging modalities.

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Section: Discussionmentioning

confidence: 99%

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Kocic,

Vukomanovic,

Djukic

et al. 2023

Medicina

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“…A relative washout >40% and an absolute washout >60% support the diagnosis of a benign mass. [19][20][21][22][23] Recently, contrast-enhanced washout CT has come under scrutiny due to newer data evaluating its test properties. [21][22][23] Limitations of the adrenal washout CT test relate to both false-positive and false-negative rates.…”

Section: Clinical Principlementioning

confidence: 99%

“…[19][20][21][22][23] Recently, contrast-enhanced washout CT has come under scrutiny due to newer data evaluating its test properties. [21][22][23] Limitations of the adrenal washout CT test relate to both false-positive and false-negative rates. It is now widely known that roughly 1/3 of pheochromocytomas may washout in the characteristic range of an adenoma.…”

Section: Clinical Principlementioning

confidence: 99%

Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass

Rowe

Kumar

Schieda

et al. 2023

CUAJ

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Guideline: Adrenal incidentaloma was evaluated as low, moderate, or high. A summary of all recommendations is displayed in Table 2. DEFINITION OF ADRENAL INCIDENTALOMAAn adrenal incidentaloma is an adrenal mass detected on cross-sectional imaging performed for an unrelated indication. The imaging test could not have been ordered to evaluate symptoms of adrenal hormone excess or a suspected adrenal mass. Adrenal masses identified on imaging studies performed for tumor staging in patients with a known cancer are also not considered adrenal incidentalomas. Generally, these masses are found during the workup of signs/symptoms not felt to be related to the adrenal glands, such as abdominal or back pain. Adrenal incidentalomas must also be equal to or greater than 1 cm in size. 1 WORKUP OF AN INCIDENTALLY DETECTED ADRENAL MASSThe differential diagnosis for an adrenal incidentaloma is broad. These masses can be broken down into three categories: benign non-functioning, benign hyperfunctioning, and malignant lesions. A full breakdown of potential etiologies of adrenal masses and their estimated prevalence is presented in Table 3. [1][2][3][4] The most common lesion is a benign non-functioning adrenal adenoma. These are estimated to make up 75% of adrenal incidentalomas. Other potential benign adrenal masses include myelolipomas, cysts, lymphangiomas, and ganglioneuromas.

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“…A relative washout >40% and an absolute washout >60% supports the diagnosis of a benign mass. [15][16][17][18] Weak Low 15 Shared decision-making between patients and their clinicians should be used for the management of indeterminate non-functional adrenal lesions. Management options include repeat imaging in 3-6 months versus surgical resection.…”

Section: Radiologic Evaluationmentioning

confidence: 99%

“…Recently, contrast-enhanced washout CT has come under scrutiny due to newer data evaluating its test properties. 17,18 Limitations of the adrenal washout CT relate to both false positive and false negative rates. Roughly 1/3 of pheochromocytomas may washout in the characteristic range of an adenoma.…”

Section: Clinical Principlementioning

confidence: 99%

Diagnosis, Management, and Follow-Up of the Incidentally Discovered Adrenal Mass: CUA Guideline Endorsed by the AUA

Rowe,

Kumar,

Schieda

et al. 2023

Journal of Urology

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Purpose: Incidental adrenal masses are common and require a multidisciplinary approach to evaluation and management that includes family physicians, urologists, endocrinologists, and radiologists. The purpose of this guideline is to provide an updated approach to the diagnosis, management, and follow-up of adrenal incidentalomas, with a special focus on the areas of discrepancy/ controversy existing among the published guidelines from other associations. Materials and Methods: This guideline was developed by the Canadian Urological Association (CUA) through a working group comprised of urologists, endocrinologists, and radiologists and subsequently endorsed by the American Urological Association (AUA). A systematic review utilizing the GRADE approach served as the basis for evidence-based recommendations with consensus statements provided in the absence of evidence. For each guideline statement, the strength of recommendation was reported as weak or strong, and the quality of evidence was evaluated as low, medium, or high. Results: The CUA working group provided evidence-and consensus-based recommendations based on an updated systematic review and subject matter expertise. Important updates on evidence-based radiological evaluation and hormonal testing are included in the recommendations. This guideline clarifies which patients may benefit from surgery and highlights where short term surveillance is appropriate. Conclusion: Incidentally detected adrenal masses require a comprehensive assessment of hormonal function and oncologic risk. This guideline provides a contemporary approach to the appropriate clinical, radiographic, and endocrine assessments required for the evaluation, management, and follow-up of patients with such lesions.

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Incidental Adrenal Nodules in Patients Without Known Malignancy: Prevalence of Malignancy and Utility of Washout CT for Characterization—A Multiinstitutional Study

Cited by 24 publications

References 32 publications

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Can MDCT Enhancement Patterns Be Helpful in Differentiating Secretory from Non-Functional Adrenal Adenoma?

Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass

Diagnosis, Management, and Follow-Up of the Incidentally Discovered Adrenal Mass: CUA Guideline Endorsed by the AUA

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