Primary adrenocortical carcinoma: CT evaluation with clinical correlation

Fishman, E K; Deutch, BM; Hartman, David S.; Goldman, S M; Zerhouni, E A; Ss, Siegelman

doi:10.2214/ajr.148.3.531

Cited by 156 publications

(77 citation statements)

References 5 publications

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“…On the other hand, the presence of ill-defined margins is often a sign of a more aggressive nature. ACCs are typically ill-defined, heterogeneous, and irregular lesions with calcifications in up to 30% of cases (5,24,25). In this study, 21 out of 25 BATs (84%) had a well-defined margin, and 28 out of 51 ACCs (55%) were also well defined.…”

Section: European Journal Of Endocrinologymentioning

confidence: 51%

Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry

Petersenn¹,

Richter²,

Broemel³

et al. 2015

European Journal of Endocrinology

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Objective: Thresholds of 2-20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs. Design: Retrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005-2010 was performed. Methods: Tumor density was evaluated in unenhanced CT by two blinded investigators. Results: Median tumor size was 9 cm (range 2.0-20) for ACCs vs 4 cm (2.0-7.5) for BATs (P!0.0001). In ACCs, the median unenhanced HU value was 34 (range 14-74) in comparison with 5 (K13 to 40) in BATs (P!0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%. Conclusions: This first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU O21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.

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Section: European Journal Of Endocrinologymentioning

confidence: 51%

Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry

Petersenn¹,

Richter²,

Broemel³

et al. 2015

European Journal of Endocrinology

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“…None of these features can be considered a definitive sign of malignancy. Calcifications, present in about 30 % of ACC [21,22], are rarely seen also in adenomas and are present in 10 % of pheochromocytomas [23] and either benign or malignant adrenal lesions show heterogeneous density, particularly after intravenous contrast medium. Even the presence of well-defined margins does not indicate necessarily benignity [22].…”

Section: Unenhanced Ctmentioning

confidence: 99%

Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology (SIE)

Stigliano

Chiodini

Giordano

et al. 2015

J Endocrinol Invest

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“…Calcification, hemorrhage and necrosis are common (39). On magnetic resonance imaging (MRI), malignancies usually show high signal intensity on T2-weighted images, whereas most benign tumors have isointense or low signal intensity on both T1-and T2-weighted images.…”

Section: Imaging Studiesmentioning

confidence: 99%

A comprehensive approach to adrenal incidentalomas

Mantero

Albiger

2004

Arq Bras Endocrinol Metab

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Improvements in abdominal imaging techniques have increased the detection of clinically inapparent adrenal masses, or incidentalomas (AI), the appropriate diagnosis and management of which have become a common clinical problem for health care professionals. Once an adrenal mass has been detected, the clinician needs to address two questions: 1) is the tumor hormonally active? and 2) is there any chance of the mass being malignant? The majority of AI is nonhypersecretory cortical adenomas, but an endocrine evaluation can lead to the identification of subtle hormone excess. An overnight lowdose dexamethasone suppression test, fractionated urinary or plasma metanephrine assay and, in hypertensive patients, establishing the upright plasma aldosterone/plasma renin activity ratio are recommended as preliminary screening steps. Masses greater than 4cm are at greater risk of malignancy. Morphological imaging features may be helpful in the distinction between benign and malignant forms. Fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients to establish any metastatic disease. Adrenalectomy is indicated by evidence of a functional adrenal mass, or a suspected malignant form. We advocate adrenalectomy of subtle hypercortisolism, especially in the presence of hypertension, obesity, diabetes or osteoporosis potentially aggravated by glucocorticoid excess. A close followup is needed, particularly in the first year after diagnosis. O aperfeiçoamento das técnicas de imagem abdominal tem aumentado a detecção de massas adrenais clinicamente não aparentes, ou incidentalomas (IA), cujo diagnóstico e manuseio apropriados têm se tornado um problema clínico comum para os profissionais da saúde. Uma vez detectada uma massa adrenal, o clínico é obrigado a formular duas questões: 1) o tumor é hormonalmente ativo? e 2) existe alguma possibilidade de a massa ser maligna?. A maioria dos IA são adenomas corticais não hipersecretores, mas uma avaliação endócrina pode resultar na identificação de um excesso hormonal sutil. Como passos preliminares de screening são recomendados um teste de supressão overnight com doses baixas de dexametasona, a dosagem de metanefrinas em urina fracionada ou no plasma e, em pacientes hipertensos, estabelecer a relação da aldosterona plasmática/atividade plasmática de renina na posição ortostática. Massas maiores que 4cm têm risco maior de malignidade. Achados morfológicos de imagem podem ser valiosos na distinção entre formas benignas e malignas. A biópsia de aspiração com agulha fina é um procedimento importante na avaliação de pacientes oncológicos para se estabelecer qualquer doença metastática. Adrenalectomia está indicada na evidência de uma massa adrenal funcionante, ou na suspeita de atualização A Comprehensive Approach to Adrenal Incidentalomas

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Primary adrenocortical carcinoma: CT evaluation with clinical correlation

Abstract: Tumors metastasized to liver (n = 9), lung (n = 5), and lymph nodes (n = 5).

Cited by 156 publications

References 5 publications

Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry

Computed tomography criteria for discrimination of adrenal adenomas and adrenocortical carcinomas: analysis of the German ACC registry

Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology (SIE)

A comprehensive approach to adrenal incidentalomas

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