Metastases or benign adrenal lesions in patients with histopathological verification of lung cancer: Can CT texture analysis distinguish?

Abstract

Introduction: Distant metastases are found in the many of patients with lung cancer at time of diagnosis. Several diagnostic tools are available to distinguish between metastatic spread and benign lesions in the adrenal gland. However, all require additional diagnostic steps after the initial CT. The purpose of this study was to evaluate if texture analysis of CT-abnormal adrenal glands on the initial CT correctly differentiates between malignant and benign lesions in patients with confirmed lung cancer. Materials and methods: In this retrospective study 160 patients with endoscopic ultrasound-guided biopsy from the left adrenal gland and a contrast-enhanced CT in portal venous phase were assessed with texture analysis. A region of interest encircling the entire adrenal gland was used and from this dataset the slice with the largest cross section of the lesion was analyzed individually. Results: Several texture parameters showed statistically significantly difference between metastatic and benign lesions but with considerable between-groups overlaps in confidence intervals. Sensitivity and specificity were assessed using ROC-curves, and in univariate binary logistic regression the area under the curve ranged from 36 % (Kurtosis 0.5) to 69 % (Entropy 2.5) compared to 73 % in the best fitting model using multivariate binary logistic regression. Conclusion:In lung cancer patients with abnormal adrenal gland at imaging, adrenal gland texture analyses appear not to have any role in discriminating benign from malignant lesions.

Diagnostic Accuracy of CT Texture Analysis in Adrenal Masses: A Systematic Review

“…In six studies, histopathological examination was used as a gold standard reference to confirm the malignant or benign nature of the adrenal tumours [ 15 , 16 , 17 , 18 , 19 , 20 ]. Two studies used a combination of histopathological and follow-up data [ 21 , 22 ].…”

“…Six studies included adrenal metastases among malignant adrenal lesions [ 15 , 16 , 18 , 19 , 20 , 22 , 23 ]. Two studies focused the analysis on the differential diagnosis between adrenal cortisol lesions (ACC and adenomas) [ 17 , 21 ].…”

“…Three studies included only CT scans after injection of intravenous contrast medium [ 16 , 18 , 20 ], while the others reported the employment of both unenhanced and contrast-enhanced CT images for texture analysis.…”

“…The most frequently used software for texture analysis was TexRAD (n = 3) [ 15 , 16 , 18 ], followed by PyRadiomics (n = 2) [ 17 , 20 ].…”

Protective effects of ulinastatin on rats with acute lung injury induced by lipopolysaccharide

“…Pathological findings were scored from 0 to 4 points: 0, without injury; 1 point, mild injury (with an area of about 25% of optical field); 2 points, moderate injury (with an area of about 50% of optical field); 3 points, severe injury (with an area of about 75% of optical field); 4 points, injury covers almost the entire optical field. The sections were observed and paragraphed by experienced pathologists in a blinded manner under a light microscope [12].…”