Adrenal Incidentalomas During Diagnostic Work-up of Colorectal Cancer Patients: What is the Risk of Metastases?

Broek, Joris van den; Geenen, Remy W. F.; Heijnen, Luc A.; Kobus, Carolien; Schreurs, Hermien

doi:10.1245/s10434-018-6501-y

Cited by 14 publications

(12 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results support the previously reported prevalence of adrenal incidentalomas discovered during follow-up of patients with colorectal carcinoma (6.8%-10.5%) ( 14 , 15 ). Similarly, most of those reported lesions were non-metastatic.…”

Section: Discussionsupporting

confidence: 92%

The prevalence and spectrum of reported incidental adrenal abnormalities in abdominal computed tomography of cancer patients: The experience of a comprehensive cancer center

et al. 2022

View full text Add to dashboard Cite

BackgroundThe increasing use of computed tomography (CT) has identified many patients with incidental adrenal lesions. Further evaluation of these lesions is often dependent on the language used in the radiology report. Compared to the general population, patients with cancer have a higher risk for adrenal abnormalities, yet data on the prevalence and type of incidental adrenal lesions reported on radiologic reports in cancer patients is limited. In this study, we aimed to determine the prevalence and nature of adrenal abnormalities as an incidental finding reported on radiology reports of cancer patients evaluated for reasons other than suspected adrenal pathology.MethodsRadiology reports of patients who underwent abdominal CT within 30 days of presentation to a tertiary cancer center were reviewed and analyzed. We used natural language processing to perform a multi-class text classification of the adrenal reports. Patients who had CT for suspected adrenal mass including adrenal protocol CT were excluded. Three independent abstractors manually reviewed abnormal and questionable results, and we measured the interobserver agreement.ResultsFrom June 1, 2006, to October 1, 2017, a total of 600,399 abdominal CT scans were performed including 66,478 scans obtained within 30 days of the patient’s first presentation. Of these, 58,512 were eligible after applying the exclusion criteria. Adrenal abnormalities were identified in 7,817 (13.4%) reports, with adrenal nodularity (3,401 [43.5%]), adenomas (1,733 [22.2%]), and metastases (1,337 [17.1%]) being the most reported categories. Only 10 cases (0.1%) were reported as primary adrenal carcinomas and 2 as pheochromocytoma. Interobserver agreement using 300 reports yielded a Fleiss kappa of 0.893, implying almost perfect agreement between the abstractors.ConclusionsIncidental adrenal abnormalities are commonly reported in abdominal CT reports of cancer patients. As the terminology used by radiologists to describe these findings greatly determine the subsequent management plans, further studies are needed to correlate some of these findings to the actual confirmed diagnosis based on hormonal, histological and follow-up data and ascertain the impact of such reported findings on patients’ outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

The prevalence and spectrum of reported incidental adrenal abnormalities in abdominal computed tomography of cancer patients: The experience of a comprehensive cancer center

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Thyroid carcinoma accounted for only 0.8% of the primary lesions in patients with AM in this study. In terms of the staging of extra-adrenal malignancies, patients with AM were more likely to be in the late stage, while those with ABM were more likely to be in the early stage, which is consistent with the findings of previous studies ( 8 , 15 , 16 ).…”

Section: Discussionsupporting

confidence: 91%

Distinguishing between metastatic and benign adrenal masses in patients with extra-adrenal malignancies

Chen

Zeng

et al. 2022

Front. Endocrinol.

View full text Add to dashboard Cite

Background and ObjectivesThe adrenal gland is a common organ involved in metastasis. This study aimed to compare adrenal metastases (AMs) and adrenal benign masses (ABMs) of patients with extra-adrenal malignancies during the staging or follow-up.MethodsWe retrospectively collected data from 120 patients with AMs and 87 patients with ABMs. The clinical characteristics, imaging features, pathology, and treatment regimes were analyzed.ResultsThe most common types of extra-adrenal malignancies in patients with ABMs included thyroid, kidney, and gynecological cancers. On the other hand, lung and kidney cancers and lymphoma were the most frequent primary cancers of AMs. The age and incidence of symptoms were significantly higher in patients with AM. Radiological analysis showed that AMs tended to have larger tumor sizes and higher attenuation values than ABMs on pre-contrast computed tomography (CT). The diagnostic accuracy of positron emission tomography-CT for AM was 94.1%. An adrenal biopsy had a diagnostic accuracy of 92.5%. A multivariate logistic regression model demonstrated that the origins of extra-adrenal malignancies, the enhancement pattern, and attenuation values in pre-contrast CT were independent predictors of AMs. The sensitivity and specificity of this predictive model of combination was 92.5% and 74.1%, respectively.ConclusionsThe differential diagnosis between AMs and ABMs is extremely important. The combination of origin of first malignancy, enhancement pattern and CT value in non-enhanced phase is a valuable model for predicting AMs.

show abstract

“…A recent population-based cohort study reported a 7.5% prevalence of metastasis in AIs, and that malignancy was 22 times more likely when the AI was discovered during cancer staging [ 8 ]. In patients with Colo-Rectal Cancer, the incidence of AIs was 10.5% (in 475 subjects); however, adrenal metastases could be ruled out in most cases (96%) with CT re-evaluation, follow-up imaging and multidisciplinary evaluation [ 9 ]. However, it is personal opinion of the authors that if an imaging study was performed during the evaluation of known extra-adrenal cancer, the AI does not fall into the definition of “incidentaloma”, because the imaging itself has been performed in a patient with an active malignancy, therefore the pre-test probability that the adrenal lesion represents a metastasis is high.…”

Section: Question 1: Is It Malignant?mentioning

confidence: 99%

Frequently asked questions and answers (if any) in patients with adrenal incidentaloma

Ceccato

Barbot

Scaroni

et al. 2021

J Endocrinol Invest

View full text Add to dashboard Cite

Purpose Adrenal incidentalomas (AIs) are incidentally discovered adrenal masses, during an imaging study undertaken for other reasons than the suspicion of adrenal disease. Their management is not a minor concern for patients and health-care related costs, since their increasing prevalence in the aging population. The exclusion of malignancy is the first question to attempt, then a careful evaluation of adrenal hormones is suggested. Surgery should be considered in case of overt secretion (primary aldosteronism, adrenal Cushing’s Syndrome or pheochromocytoma), however the management of subclinical secretion is still a matter of debate. Methods The aim of the present narrative review is to offer a practical guidance regarding the management of AI, by providing evidence-based answers to frequently asked questions. Conclusion The clinical experience is of utmost importance: a personalized diagnostic-therapeutic approach, based upon multidisciplinary discussion, is suggested.

show abstract

Adrenal Incidentalomas During Diagnostic Work-up of Colorectal Cancer Patients: What is the Risk of Metastases?

Abstract: This is the first study to report on adrenal incidentalomas in CRC patients. In newly diagnosed CRC patients without disseminated disease, AIs can be considered benign, and no additional imaging is indicated to rule out adrenal metastases in this group.

Cited by 14 publications

References 15 publications

The prevalence and spectrum of reported incidental adrenal abnormalities in abdominal computed tomography of cancer patients: The experience of a comprehensive cancer center

The prevalence and spectrum of reported incidental adrenal abnormalities in abdominal computed tomography of cancer patients: The experience of a comprehensive cancer center

Distinguishing between metastatic and benign adrenal masses in patients with extra-adrenal malignancies

Frequently asked questions and answers (if any) in patients with adrenal incidentaloma

Contact Info

Product

Resources

About