Elsevier

Endocrine Practice

Volume 16, Issue 4, July–August 2010, Pages 577-587
Endocrine Practice

Original Article
Change in Adrenal Mass Size as a Predictor of a Malignant Tumor

https://doi.org/10.4158/EP09351.ORGet rights and content

ABSTRACT

Objective

To assess the value of adrenal mass absolute growth, growth rate, and percentage growth rate on serial imaging for distinguishing benign from malignant adrenal masses.

Methods

We retrospectively reviewed the Cleveland Clinic medical record data on 136 adrenalectomies or biopsies in 132 patients with 2 imaging studies performed more than 2 months apart (during 1997 to 2008).

Results

There were 111 benign (81.6%) and 25 malignant (18.4%) adrenal masses. With use of receiver operating characteristic curve analysis, all 3 aforementioned growth measures showed similar levels of discrimination for the entire study group as well as for the subgroups with 3 to 12 months of follow-up (n = 75 masses) and noncontrast computed tomography Hounsfield units > 10 or not reported (n = 111 masses). After adjustment for other factors, the 3 growth measures remained statistically significant predictors of a malignant tumor. The absolute growth cutoff value of 0.8 cm had the highest sum of sensitivity and specificity of 72% and 81.1%, respectively. We could not identify an adrenal mass growth cutoff value to provide 100% sensitivity or specificity to confirm or exclude the presence of a malignant lesion. In 3 patients with metastatic lesions, no growth or a decrease in mass size during a period of 4 to 36 months was observed.

Conclusion

In this study, the largest with surgical histopathology findings as the “gold standard” for diagnosis, change in adrenal mass size was a significant predictor of a malignant tumor. Nevertheless, we could not identify an adrenal mass growth cutoff value for reliable confirmation or exclusion of a malignant lesion. Change in adrenal mass size should be used in conjunction with other imaging and clinical characteristics when surgical resection is being considered. (Endocr Pract. 2010;16:577-587)

Section snippets

INTRODUCTION

The development of modern imaging techniques such as ultrasonography, computed tomography (CT), and magnetic resonance imaging has led to the detection of adrenal masses in patients with increasing frequency. Adrenal masses are found in up to 5% of patients undergoing CT scans of the abdomen (1., 2., 3., 4., 5.).

Whatever the reason for the discovery of an adrenal mass, one must determine whether the mass is functional or malignant (or both). Functionality or malignancy usually necessitates

PATIENTS AND METHODS

The data for this retrospective review study were extracted from an adrenal database approved by the Cleveland Clinic Institutional Review Board.

RESULTS

The baseline categorical and continuous variables of patients who underwent adrenalectomy or biopsy from 1997 to 2008 at the Cleveland Clinic and had 2 or more imaging studies, performed more than 2 months apart, are shown in Table 1 and Table 2, respectively. The 132 study subjects, when compared with the 740 patients in the database, were found to be older (mean ± SD) (57.4 ± 13.1 years versus 54.5 ± 15.0 years; P = .04), have more nonfunctional masses (50.0% versus 27.7%; P < .001), and have a

CONCLUSION

In the current study, the largest with histopathology results as the criterion standard for diagnosis, change in adrenal mass size on serial imaging was a statistically significant predictor of a malignant lesion, with the absolute growth cut point of 0.8 cm during a follow-up period of 3 to 12 months yielding the highest sum of sensitivity and specificity. We were unable, however, to identify a growth cut point, for a given growth measure, that provided 100% sensitivity or specificity for

ACKNOWLEDGMENT

We thank James Bena and Anne Tang from the Department of Biostatistics, Cleveland Clinic, and Dr. Shikhar Agarwal, from the Medicine Institute, Cleveland Clinic, for their skillful help with statistical analysis and preparation of the figures. Some of this material was presented at the 91st Annual Meeting of The Endocrine Society; June 10-13, 2009; Washington, DC, and subsequently published in abstract form by them.

DISCLOSURE

The authors have no multiplicity of interest to disclose.

REFERENCES (33)

  • A Virkkala et al.

    Endocrine abnormalities in patients with adrenal tumours incidentally discovered on computed tomography

    Acta Endocrinol (Copenh)

    (1989)
  • F Jockenhövel et al.

    Conservative and surgical management of incidentally discovered adrenal tumors (incidentalomas)

    J Endocrinol Invest

    (1992)
  • G Osella et al.

    Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas)

    J Clin Endocrinol Metab

    (1994)
  • Z Bencsik et al.

    Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach

    J Intern Med

    (1995)
  • A Courtade et al.

    Outcome of incidental adrenal masses not operated on: 44 cases over 7 years

    Eur J Surg

    (1997)
  • EA Bastounis et al.

    Incidentalomas of the adrenal gland: diagnostic and therapeutic implications

    Am Surg

    (1997)
  • Cited by (50)

    • ACR Appropriateness Criteria® Adrenal Mass Evaluation: 2021 Update

      2021, Journal of the American College of Radiology
    • Approach to the Patient with an Incidental Adrenal Mass

      2021, Medical Clinics of North America
    • Management of the Incidental Adrenal Mass

      2016, European Urology Focus
    View all citing articles on Scopus
    View full text