Adrenal lesions in patients with extra-adrenal malignancy – benign or malignant?

Hammarstedt, Lilian; Muth, Andreas; Sigurjónsdóttir, Hrefna; Almqvist, Erik G.; Wängberg, Bo; Hellström, Mikael

doi:10.3109/0284186x.2011.608084

Cited by 18 publications

(13 citation statements)

References 19 publications

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“…A solitary adrenal mass is identified at the time of the cancer diagnosis or during follow‐up in many oncology patients. Similar to the results of our study, previous studies have shown that metachronous adrenal mass in patients with cancer more often metastasized than synchronous adrenal mass . Howell et al, in a study in which the largest proportion of primary cancers were of the lung (50%), reported that 51 of 61 patients with adrenal metastasis had metachronous mass .…”

Section: Discussionsupporting

confidence: 91%

“…Similar to the results of our study, previous studies have shown that metachronous adrenal mass in patients with cancer more often metastasized than synchronous adrenal mass. 2,5 Howell et al, in a study in which the largest proportion of primary cancers were of the lung (50%), reported that 51 of 61 patients with adrenal metastasis had metachronous mass. 23 In a study involving a large proportion of RCC cases (57%), Lenert et al showed that metachronous adrenal metastasis was more common than synchronous metastasis in patients with extra-adrenal malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…As well as being discovered incidentally, adrenal lesions are often observed during staging workup or imaging follow‐up in patients with extra‐adrenal malignancy. Adrenal lesions in patients with extra‐adrenal malignancy are benign in approximately 30% to 70% of cases depending on tumor type and patient selection . If adrenal mass is found in patients with known extra‐adrenal malignancy, it is important to approach benign lesions and metastasis using different therapeutic algorithms.…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

Byeon

Choi

et al. 2018

Journal of Surgical Oncology

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Background and Objectives The adrenal gland is a frequent site for metastasis, and a solitary adrenal mass is often observed during staging workup or imaging follow‐up in patients with extra‐adrenal malignancy. To create an appropriate management plan, it is essential to distinguish between benign adrenal lesions and metastasis in patients with extra‐adrenal cancer having solitary adrenal masses. Therefore, here we evaluated the predictive factors for adrenal metastasis in patients with extra‐adrenal malignancy having solitary adrenal mass. Materials and Methods From September 2003 to June 2016, we retrospectively reviewed patients with extra‐adrenal malignancy having solitary adrenal mass on a cancer staging workup or follow‐up study who subsequently underwent adrenalectomy at our institution. All patients underwent preoperative functional studies; those with positive results were excluded from this study. Characteristics of oncology patients with adrenal mass including age, sex, body mass index, smoking, mass location, mass size, hypertension, diabetes mellitus, precontrast Hounsfield unit (HU), and synchronous or metachronous adrenal mass based on the time of the extra‐adrenal cancer diagnosis were analyzed. Results Of the total 68 patients with extra‐adrenal cancer having solitary adrenal mass, 22 had pathologically confirmed adrenal metastasis. Primary cancers consisted of hepatocellular cell carcinoma (n = 7), renal cell carcinoma (n = 7), lung cancer (n = 4), colon cancer (n = 3), and breast cancer (n = 1). On multivariate analysis, a higher precontrast HU (P = 0.001, odds ratio [OR] = 1.105, 95% confidence interval [CI] = 1.042‐1.172), male sex ( P = 0.019, OR = 9.782, 95% CI = 1.462‐65.461), and metachronous adrenal mass ( P = 0.007, OR = 11.090, 95% CI = 1.937‐63.490) were observed as predictive factors for adrenal metastasis in patients with extra‐adrenal cancer having solitary adrenal mass. The cut‐off value of precontrast HU to distinguish between metastasis and benign lesions was 36.2 (sensitivity = 81.8%; specificity = 91.3%). Conclusion High precontrast HU (> 36), male sex, and metachronous adrenal mass are predictive factors for adrenal metastasis in patients with extra‐adrenal malignancy having solitary adrenal mass.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

Byeon

Choi

et al. 2018

Journal of Surgical Oncology

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“…Our study observed that an unenhanced CT attenuation value of ≥10 HU for an adrenal lesion is highly sensitive but poorly specific (31% -39%) for malignancy. The high sensitivity is in accordance with adrenalectomy histopathologic findings when correlated with imaging characteristics [38]. In order to improve specificity, recent studies recommend using cut-off values of 20 HU or 25 HU to achieve specificities of 60% or 72%, respecttively [9].…”

Section: Discussionsupporting

confidence: 54%

EUS FNA of Altered Left Adrenal Gland Morphology Suggests Amending CT and PET-CT Attenuation Threshold Values That Predict Malignancy

Gleeson¹,

Clapp²,

Murphy³

et al. 2012

JCT

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Introduction: In the setting of an extra-adrenal malignancy, it is a recognized clinical challenge to try and distinguish a benign adrenal mass from a metastatic deposit. Current non-invasive diagnostic tools for adrenal gland evaluation include CT, MRI, PET and PET-CT. Diagnostic interpretative error can occur as evaluations rarely have complete cytologic or histologic correlation for concordance purposes. Aims: To establish the performance characteristics of non-contrast CT attenuation values (Hounsfield units-HU) and the optimal PET-CT maximum standard uptake value (SUVmax) for predicting adrenal malignancy when correlated with adrenal gland endoscopic ultrasound fine needle aspiration (EUS FNA) cytology results. Methods: A prospectively maintained EUS database was reviewed to identify consecutive patients who underwent a left adrenal gland FNA. Non-contrast CT attenuation values and SUVmax scores were calculated. EUS FNA cytology results were used as the reference standard for determining the presence of benign versus malignant adrenal gland status. Results: Sixty-two patients (69 ± 11 years) underwent adrenal EUS FNA, 34 (54.8%) of whom had a clinically suspected or established extra-adrenal malignancy. Non-invasive imaging was suggestive of abnormal adrenal morphology or altered PET-CT FDG activity in 45 (72.6%) patients. Elevated attenuation values (≥10 HU) by non-enhanced CT had a sensitivity and specificity of 100% and 34.6%, respectively. The SUVmax for malignant altered morphology was significantly higher than that for benign lesions [(8.5 ± 3.1 vs 3.3 ± 0.7; (p = 0.0001)]. ROC curve analysis indicated that an optimum cutoff SUVmax of ≥4.1 (AUC 0.92) yielded the best power distinction for malignancy with a sensitivity and specificity of 89% and 100%. Conclusion: When evaluating altered adrenal morphology by non-invasive methods, the performance characteristics of elevated CT attenuation values are suboptimal. But by adopting a SUVmax cut-off value of ≥4.1 could potentially improve such characteristics to detect malignancy

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“…Although the risk of an adrenal malignancy is higher in patients with a history of malignancy, Hammarstedt et al demonstrated that up to 74 % of these lesions are still likely benign when assessed by imaging criteria and recommended long-term follow-up, especially when no other concurrent malignancy is radiographically evident. 4,21 Furthermore, the incidence of a solitary metastatic lesion to the adrenal was unusual (\10 %) in a recent review of our institutional data. 22 The practice at our institution is to evaluate unilateral adrenal lesions in patients who have a history of extra-adrenal malignancy with standard biochemical testing and imaging characterization and use indications for resection that do not necessarily differ from patients who do not have a personal history of cancer.…”

Section: Discussionmentioning

confidence: 95%

Adrenal Imaging Features Predict Malignancy Better than Tumor Size

et al. 2015

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Adrenal lesions in patients with extra-adrenal malignancy – benign or malignant?

Cited by 18 publications

References 19 publications

Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

EUS FNA of Altered Left Adrenal Gland Morphology Suggests Amending CT and PET-CT Attenuation Threshold Values That Predict Malignancy

Adrenal Imaging Features Predict Malignancy Better than Tumor Size

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