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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Adrenal tumor size ≥ 4 cm is a common indication for adrenalectomy due to malignancy concerns.
  • This study compares mass size to imaging features (ImF) for diagnostic accuracy of adrenal malignancy.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of imaging features (ImF) versus mass size in identifying adrenal malignancy.
  • To determine optimal criteria for adrenalectomy in suspected adrenal tumors.

Main Methods:

  • Retrospective analysis of 112 patients who underwent adrenalectomy.
  • Imaging features (ImF) classified as nonbenign based on CT (HU > 10) or MRI (loss of signal absence).
  • Comparison of diagnostic performance (sensitivity, specificity, NPV, PPV) of ImF and size (≥ 4 cm) in predicting malignancy.

Main Results:

  • 18% of resected adrenal tumors were malignant (20/113).
  • Non-benign ImF demonstrated 100% sensitivity and 57% specificity for malignancy.
  • Mass size ≥ 4 cm had lower sensitivity (55%) but similar specificity (61%) for malignancy.

Conclusions:

  • Non-benign ImF are more sensitive than mass size for detecting adrenal malignancy.
  • Adrenalectomy should be considered for adrenal tumors with non-benign ImF, irrespective of size.
  • Relying solely on size ≥ 4 cm risks missing a significant proportion of malignant adrenal tumors.