Endocrinol Metab.  2016 Mar;31(1):147-152. 10.3803/EnM.2016.31.1.147.

Radiographic Characteristics of Adrenal Masses in Oncologic Patients

• Lee JH
• Kim EK
• Hong AR
• Roh E
• Bae JH
• Kim JH
• Shin CS
• Kim SY
• Kim SW

• KMID: 2169706
• DOI: http://doi.org/10.3803/EnM.2016.31.1.147

Abstract

BACKGROUND
We aimed to assess the usefulness of pre-contrast Hounsfield unit (HU) and mass size on computed tomography to differentiate adrenal mass found incidentally in oncologic patients.
METHODS
From 2000 to 2012, 131 oncologic patients with adrenal incidentaloma were reviewed retrospectively. Receiver operating characteristic (ROC) curves were applied to determine the optimal cut-off value of the mean HU and size for detecting adrenal metastasis.
RESULTS
The median age was 18 years, and 80 patients were male. The initial mass size was 18 mm, and 71 (54.2%) of these were on the left side. A bilateral adrenal mass was found in 11 patients (8.4%). Biochemically functional masses were observed in 9.2% of patients. Thirty-six out of 119 patients with nonfunctional masses underwent adrenalectomy, which revealed metastasis in 13. The primary cancers were lung cancer (n=4), renal cell carcinoma (n=2), lymphoma (n=2), hepatocellular carcinoma (n=2), breast cancer (n=1), and others (n=2). The area under the curve for the size and HU for clinically suspicious metastasis were 0.839 (95% confidence interval [CI], 0.761 to 0.900; P<0.001) and 0.959 (95% CI, 0.898 to 0.988; P<0.001), respectively. The cut-off value to distinguish between metastasis and benign masses were 22 mm for size and 20 for HU.
CONCLUSION
ROC curve results suggest that pre-contrast HU >20 can be used as a diagnostic reference to suggest metastasis in oncologic patients with adrenal masses.

Keyword

Adrenal incidentaloma; Metastasis; Neoplasms

MeSH Terms

Adrenalectomy
Breast Neoplasms
Carcinoma, Hepatocellular
Carcinoma, Renal Cell
Humans
Lung Neoplasms
Lymphoma
Male
Neoplasm Metastasis
Retrospective Studies
ROC Curve

Figure

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  Fig. 1 Flow chart of follow-up for cancer patients with adrenal incidentaloma (AI). PET-CT, positron emission tomography-computed tomography; MRI, magnetic resonance imaging; FNA, fine needle aspiration.

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  Fig. 2 (A) Adrenal size and (B) Hounsfield unit (HU) for clinically suspicious benign (b) and metastasis (m).

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  Fig. 3 (A) Absolute percentage washout (APW) and (B) relative percentage washout (RPW) in case adrenal mass with Hounsfield unit over 10. b, clinically suspicious benign; m, clinically suspicious metastasis.

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  Fig. 4 Receiver operating characteristic curve for adrenal mass defined as clinically suspicious metastasis. HU, Hounsfield unit; PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve; CI, confidence interval.

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