Management of incidentally discovered adrenal masses and risk of malignancy

被引:72
作者
Favia, G [1 ]
Lumachi, F [1 ]
Basso, S [1 ]
D'Amico, DF [1 ]
机构
[1] Univ Padua, Dept Surg & Gastroenterol Sci, Endocrine Surg Unit, I-35128 Padua, Italy
关键词
D O I
10.1067/msy.2000.109965
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Incidentally discovered adrenal masses of more than. 1 cm in size are relatively frequent, but the correct management of such lesions is not well established. Methods. Between 1980 and 1999, 158 patients (73 men [46.2%] and 85 women [53.8%]; median age, 58 years) with adrenal incidentalomas of more than 2 cm in size were observed. Sixty-eight patients (43.0%) underwent adrenalectomy. The main reasons for surgery were (1) suspicious computed tomography (CT) scan or magnetic resonance imaging (MRI) appearance or no uptake at the 75-Se-norcholesterol scintigraphy (NCS; n = 22 patients), (2) an increase in the size of the mass of more than 1 cm (n = 15 patients), (3) subclinical endocrine hyperfunction (n = 14 patients), and (4) mass size of more than 5 cm (n = 22 patients), with imaging-guided fine-needle aspiration biopsy with spinal-type narrow-gauge needle (FNAB) that suggested malignancy (n = 5 patients). Results. Pathologic examination showed 39 adrenocortical adenomas (57.4%), 20 adrenal malignancies (29.4%; carcinomas 15; unsuspected metastases, 3; nonfunctioning malignant pheochromocytomas 2), and 9 various benign lesions (13.2%). All masses that increased in size were benign. Seven malignant tumors (46.7%) were 3 to 4 cm in size, and 14 benign lesions (29.1%) were 5 to 6 cm in size. Sensitivity and specificity in the detection of malignancy were 100% and 100% for NCS (n = 34 patients) and FNAB(n = 19 patients) 75.0% and 93.7% for CT scan (n = 68 patients), and 87.5% and 100% for MRI (n = 26 patients), respectively. Conclusions. To differentiate benign and malignant incidentalomas, NCS and FNAB are more sensitive than CT scan and MRI; size criteria are of little value.
引用
收藏
页码:918 / 924
页数:7
相关论文
共 26 条
[1]   Can adrenal incidentalomas be safely observed? [J].
Barry, MK ;
van Heerden, JA ;
Farley, DR ;
Grant, CS ;
Thompson, GB ;
Ilstrup, DM .
WORLD JOURNAL OF SURGERY, 1998, 22 (06) :599-604
[2]   Risk factors and long-term follow-up of adrenal incidentalomas [J].
Barzon, L ;
Scaroni, C ;
Sonino, N ;
Fallo, F ;
Paoletta, A ;
Boscaro, M .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1999, 84 (02) :520-526
[3]  
Bastounis EA, 1997, AM SURGEON, V63, P356
[4]   Adrenal masses: Characterization with delayed contrast-enhanced CT [J].
Boland, GW ;
Hahn, PF ;
Pena, C ;
Mueller, PR .
RADIOLOGY, 1997, 202 (03) :693-696
[5]  
Boraschi P, 1999, JMRI-J MAGN RESON IM, V9, P304
[6]  
de Agustín P, 1999, DIAGN CYTOPATHOL, V21, P92, DOI 10.1002/(SICI)1097-0339(199908)21:2<92::AID-DC3>3.3.CO
[7]  
2-V
[8]   Pheochromocytoma, a rare cause of hypertension: Long-term follow-up of 55 surgically treated patients [J].
Favia, G ;
Lumachi, F ;
Polistina, F ;
D'Amico, DF .
WORLD JOURNAL OF SURGERY, 1998, 22 (07) :689-694
[9]   ROLE OF BILATERAL ADRENALECTOMY IN CUSHINGS-DISEASE [J].
FAVIA, G ;
BOSCARO, M ;
LUMACHI, F ;
DAMICO, DF .
WORLD JOURNAL OF SURGERY, 1994, 18 (04) :462-466
[10]   SCINTIGRAPHY OF INCIDENTALLY DISCOVERED BILATERAL ADRENAL MASSES [J].
GROSS, MD ;
SHAPIRO, B ;
FRANCIS, IR ;
BREE, RL ;
KOROBKIN, M ;
MCLEOD, MK ;
THOMPSON, NW ;
SANFIELD, JA .
EUROPEAN JOURNAL OF NUCLEAR MEDICINE, 1995, 22 (04) :315-321