Abstract
Background. Incidentally discovered adrenal masses of more than 1 cm in size are relatively frequent,
but the correct management of such lesions is not well established. Methods. Between 1980 and 1999, 158 patients (73 men [46.2%] and 85 women [53.8%]; median
age, 58 years) with adrenal incidentalomas of more than 2 cm in size were observed.
Sixty-eight patients (43.0%) underwent adrenalectomy. The main reasons for surgery
were (1) suspicious computed tomography (CT) scan or magnetic resonance imaging (MRI)
appearance or no uptake at the 75-Se-norcholesterol scintigraphy (NCS; n = 22 patients),
(2) an increase in the size of the mass of more than l cm (n = 15 patients), (3) subclinical
endocrine hyperfunction (n = 14 patients), and (4) mass size of more than 5 cm (n
= 22 patients), with imaging-guided fine-needle aspiration biopsy with spinal-type
narrow-gauge needle (FNAB) that suggested malignancy (n = 5 patients). Results. Pathologic examination showed 39 adrenocortical adenomas (57.4%), 20 adrenal malignancies
(29.4%; carcinomas, 15; unsuspected metastases, 3; nonfunctioning malignant pheochromocytomas,
2), and 9 various benign lesions (13.2%). All masses that increased in size were benign.
Seven malignant tumors (46.7%) were 3 to 4 cm in size, and 14 benign lesions (29.1%)
were 5 to 6 cm in size. Sensitivity and specificity in the detection of malignancy
were 100% and 100% for NCS (n = 34 patients) and FNAB (n = 19 patients), 75.0% and
93.7% for CT scan (n = 68 patients), and 87.5% and 100% for MRI (n = 26 patients),
respectively. Conclusions. To differentiate benign and malignant incidentalomas, NCS and FNAB are more sensitive
than CT scan and MRI; size criteria are of little value. (Surgery 2000;128:918-24.)
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Article info
Footnotes
*Reprint requests: G. Favia, MD, Endocrine Surgery Unit, Department of Surgical & Gastoenterological Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
**Surgery 2000;128:918-24.
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Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
