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Multicenter Study
. 2022 Apr 30;22(1):73.
doi: 10.1186/s12894-022-01024-5.

Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size

David Zekan  1 , Robert Scott King  2 , Ali Hajiran  3 , Apexa Patel  4 , Samuel Deem  2 , Adam Luchey  3
Affiliations
Multicenter Study

Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size

David Zekan et al. BMC Urol. .

Abstract

Introduction/background: Adrenal incidentalomas (AIs) are masses > 1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses.

Material and methods: 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, < 18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher's exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression.

Results: 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured > 6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p = 0.008 and 0.011).

Conclusions: Our results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC.

Keywords: Adrenocortical carcinoma; CT; Cross-sectional imaging; MRI; Malignancy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pathologic breakdown based on radiologic size of adrenal incidentalomas. RCC renal cell carcinoma, ACC adrenocortical carcinoma
Fig. 2
Fig. 2
Pathologic breakdown of included adrenal masses based on radiographic size categorized into the guideline-recommended cutoff for resection, this study’s suggested cutoff for resection, and those in-between, respectively
See this image and copyright information in PMC

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