Abstract
Background
Discrimination between adrenocortical carcinoma and lipid-poor cortical adenoma preoperatively
is frequently difficult as these two entities have overlapping imaging characteristics.
Differentiation will allow for the selection of the most appropriate operative approach
and may help prevent over-treatment. We aimed to identify imaging features that could
preoperatively differentiate adrenocortical carcinoma from lipid-poor cortical adenoma
and use them in a novel imaging-based score.
Methods
We conducted a retrospective analysis of patients with pathologically proven adrenocortical
carcinoma and lipid-poor cortical adenoma who underwent resection in a single tertiary
referral center between March 1998 and August 2020. The inclusion criteria were diameter
>1 cm, attenuation >10 Hounsfield units on nonenhanced computed tomography, and histopathologic
diagnosis. Patients with metastatic or locally advanced adrenocortical carcinoma adenoma
(stages 3–4) were excluded. We developed a score using binary logistic multivariate
regression model in 5-fold derivation (∼70%) cohorts with stepwise backward conditional
regression as feature selection. Standardized mean regression weight was used as variable
score points.
Results
We identified 232 adrenals resected across 211 patients. By comparing the imaging
characteristics of adrenocortical carcinoma (n = 56) and lipid-poor cortical adenoma
(n = 156), we revealed statistically significant differences between the groups in
9 parameters: size, attenuation, thin and thick rim enhancement patterns, heterogeneity,
calcification, necrosis, fat infiltration, and lymph node prominence. The score mean
performance was 100% sensitivity for the exclusion of adrenocortical carcinoma, 80%
specificity (95% confidence interval, 68.3–91.5), 66% positive predictive value (95%
confidence interval, 52.3–78.7), and 100% negative predictive value with area under
the curve of 0.974.
Conclusion
We defined and evaluated a novel 9-variable, imaging-based score. This score outperformed
any single variable and could facilitate safe preoperative discrimination of adrenocortical
carcinoma and lipid-poor cortical adenoma.
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Article info
Publication history
Published online: October 13, 2022
Accepted:
July 19,
2022
Footnotes
Tal Yalon and Mariana Yalon contributed equally to this article.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
