World Journal of Endocrine Surgery

Register      Login

VOLUME 12 , ISSUE 3 ( September-December, 2020 ) > List of Articles

Original Article

A Novel Scoring System to Correlate Preoperative Adrenal Imaging with Final Histology in Predicting Malignancy: A Retrospective Institutional Data Analysis

Kushagra Gourav, Shruti Singh

Keywords : Adrenal mass, Adrenocortical carcinoma, Adrenal Surgery, Contrast-enhanced computed tomography

Citation Information : Gourav K, Singh S. A Novel Scoring System to Correlate Preoperative Adrenal Imaging with Final Histology in Predicting Malignancy: A Retrospective Institutional Data Analysis. World J Endoc Surg 2020; 12 (3):122-127.

DOI: 10.5005/jp-journals-10002-1310

License: CC BY-NC 4.0

Published Online: 02-08-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Background and aim: To investigate whether preoperative contrast-enhanced computed tomography (CECT) will be able to differentiate benign adrenal mass from malignant mass by applying a combination of morphological criteria and correlating it with the final histopathology. Materials and methods: Thirty-six patients planned for surgery were assessed preoperatively with CECT abdomen and based on CT findings a score of 0 to 6 was given depending on the size of the lesion, margin, density, abutment/infiltration to surrounding structures, necrosis, and calcification which was further correlated with their final histopathology. Statistical test used: The reliability of the total score was checked using receiver operator characteristic (ROC) analysis. Results: Out of 36 patients, 28 were benign and 8 were malignant pathology. The presence of abutment, ill-defined margins, and necrosis on CT was found significantly more in patients with malignant pathology (p = 0.009, p = 0.005, and p = 0.009, respectively). The most sensitive and specific parameters in predicting malignancy based on CT were heterogeneity and ill-defined margins, respectively (100 and 94.6%, respectively). The cut-off score of four has a sensitivity, specificity, NPV, and PPV of 75, 82.1, 54.55, and 92%, respectively. The mean scores for benign and malignant were 2.21 ± 0.315 and 4.25 ± 1.581, respectively (p = 0.001). Conclusion: This novel scoring method including heterogeneity, margins, abutment, and necrosis plays a key role in predicting malignancy accurately on CT scans.

  1. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol 2008;190(5):1163–1168. DOI: 10.2214/AJR.07.2799.
  2. Lenert JT, Barnett CC, Kudelka AP, et al. Evaluation and surgical resection of adrenal masses in patients with a history of extra-adrenal malignancy. Surgery 2001;130(6):1060–1067. DOI: 10.1067/msy.2001.118369.
  3. Lam KY, Lo CY. Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocri 2002;56(1):95–101. DOI: 10.1046/j.0300-0664.2001.01435.x.
  4. Wang F, Liu J, Zhang R, et al. CT and MRI of adrenal gland pathologies. Quant Imaging Med Surg 2018;8(8):853–875. DOI: 10.21037/qims.2018.09.13.
  5. Gufler H, Eichner G, Grossmann A, et al. Differentiation of adrenal adenomas from metastases with unenhanced computed tomography. J Comput Assist Tomogr 2004;28(6):818–822. DOI: 10.1097/00004728-200411000-00015.
  6. Yun M, Kim W, Alnafisi N, et al. 18F-FDG PET in characterizing adrenal lesions detected on CT or MRI. J Nucl Med 2001;42(12):1795–1799.
  7. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Int Med 2003;138(5):424–429. DOI: 10.7326/0003-4819-138-5-200303040-00013.
  8. Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004;25(2):309–340. DOI: 10.1210/er.2002-0031.
  9. Young WF. Clinical practice. The incidentally discovered adrenal mass. N Eng J Med 2007;356(6):601–610. DOI: 10.1056/NEJMcp065470.
  10. Fassnacht M, Kreissl MC, Weismann D, et al. New targets and therapeutic approaches for endocrine malignancies. Pharmacol Therapeut 2009;123(1):117–141. DOI: 10.1016/j.pharmthera.2009.03.013.
  11. Boland GW, Blake MA, Hahn PF, et al. Incidental adrenal lesions: principles, techniques, and algorithms for imaging characterization. Radiology 2008;249(3):756–775. DOI: 10.1148/radiol.2493070976.
  12. Fishman EK, Deutch BM, Hartman DS, et al. Primary adrenocortical carcinoma: CT evaluation with clinical correlation. Am J Roentgenol 1987;148(3):531–535. DOI: 10.2214/ajr.148.3.531.
  13. Lattin GE, Sturgill ED, Tujo CA, et al. From the radiologic pathology archives: Adrenal tumors and tumor-like conditions in the adult: radiologic-pathologic correlation. Radiographics 2014;34(3):805–829. DOI: 10.1148/rg.343130127.
  14. Bharwani N, Rockall AG, Sahdev A, et al. Adrenocortical carcinoma: the range of appearances on CT and MRI. AJR Am J Roentgenol 2011;196(6):W706–W714. DOI: 10.2214/AJR.10.5540.
  15. Zhang HM, Perrier ND, Grubbs EG, et al. CT features and quantification of the characteristics of adrenocortical carcinomas on unenhanced and contrast-enhanced studies. Clin Radiol 2012;67(1):38–46. DOI: 10.1016/j.crad.2011.03.023.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.