Endocrine Abstracts

Introduction: Although computed tomography (CT) is the best mean to identify adrenal neoplasms there is still controversy of the concordance of the estimated radiological and histological size of the lesion. Since the size of adrenal tumours is a major criterion for surgical excision, we investigated whether recent and more sophisticated imaging techniques, can more accurately predict tumor’s size.

Methods: We have retrospectively analyzed a series of 109 patients who underwent adrenalectomy at a referral center during the period 2017 and 2018. Medical records from histological and imaging studies were registered. Radiological adrenal size (RS) was defined by CT and magnetic resonance imaging (MRI). The adrenal tumors were divided according their histological size (HS) in the following groups, A: ≤3 cm, B: >3 and ≤6 cm, C: >6 and ≤9 cm, D: >9 and ≤12 cm, E: >12 cm; 1: ≤2 cm, 2: >2 and ≤4 cm, 3: >4 and ≤6 cm, 4: >6 and ≤8 cm, 5: >8 and ≤10 cm, 6: >10 cm. The major dimension of HS (median value) was compared with the major dimension of RS (median value) by kappa statistic to define their agreement.

Results: Patients (64% females) with mean age 56.2 (range: 18-79 and one child of 10) years were submitted to adrenalectomy (71 right, 36 left, 2 bilateral). The HS had mean and median values 7.24 and 7.00 cm (range: 2–22), respectively; the RS had mean and median values 5.03 and median 4.50 cm (range: 1–22), respectively. Group A and 1 included one tumor 1.8 cm with RS 1.10 cm, group B, included 41 tumors with HS:5.5 cm versus RS:3.30 cm; group C, 57 with HS:7.5 cm versus RS:5.00 cm; group D, 7 with HS:10 cm versus RS:5.00 cm; group E, 3 with HS:19.3 cm versus RS:15.00 cm; group 2, 3 with HS:4 cm versus RS:3 cm; group 3, 38 with HS 5.50 cm versus RS 3.45 cm; group 4, 47 with HS 7.4 cm versus RS 4.8 cm; group 5, 14 with HS:9 cm versus RS:5.5 cm; group 6, 6 with HS:14.05 cm versus RS:9.8 cm. A slight agreement was seen in group B (kappa value =0.013 in total imaging and 0.028 in CT), and in group 4 (kappa value =0.015 in total imaging and 0.029 in CT),

Conclusions: The present study confirmed previous findings that adrenal imaging, either CT or MRI, cannot predict the real size of adrenal tumours implying that despite the progression of imaging technology clinicians have to consider a larger size of adrenal tumours when a decision to remove an adrenal incidentaloma has to be taken.