PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE

Abstract

You have accessJournal of UrologyCME1 May 2022PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE David Zekan, Robert King, Ali Hajiran, Apexa Patel, Samuel Deem, and Adam Luchey David ZekanDavid Zekan More articles by this author , Robert KingRobert King More articles by this author , Ali HajiranAli Hajiran More articles by this author , Apexa PatelApexa Patel More articles by this author , Samuel DeemSamuel Deem More articles by this author , and Adam LucheyAdam Luchey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adrenal incidentalomas (AIs) are masses >1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses. METHODS: 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, <18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression. RESULTS: 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured >6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p=0.008 and 0.011). CONCLUSIONS: Our results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e49 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Zekan More articles by this author Robert King More articles by this author Ali Hajiran More articles by this author Apexa Patel More articles by this author Samuel Deem More articles by this author Adam Luchey More articles by this author Expand All Advertisement PDF DownloadLoading ...