MP12-02 INCIDENTAL ADRENAL MASS: DO OUR RESULTS SUPPORT THE GUIDELINES?

You have accessJournal of UrologyAdrenal1 Apr 2016MP12-02 INCIDENTAL ADRENAL MASS: DO OUR RESULTS SUPPORT THE GUIDELINES? Paulo Dinis, Pedro Nunes, Arnaldo Figueiredo, Maria José Freire, Mario Lourenço, Belmiro Parada, and Alfredo Mota Paulo DinisPaulo Dinis More articles by this author , Pedro NunesPedro Nunes More articles by this author , Arnaldo FigueiredoArnaldo Figueiredo More articles by this author , Maria José FreireMaria José Freire More articles by this author , Mario LourençoMario Lourenço More articles by this author , Belmiro ParadaBelmiro Parada More articles by this author , and Alfredo MotaAlfredo Mota More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2442AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Incidental adrenal nodules are benign in their majority. It is recommended a functional study to detect subclinical hormonal hypersecretion. In nonfunctioning lesions with a diameter = 4cm surgery is indicated due to the increased risk of malignancy. Laparoscopic adrenalectomy is currently the surgical technique of choice with low complication rates. However there is a high rate of benign lesions excision. The objective of the study is to analyze our results evaluating the 4cm cut-off recommended by the guidelines. METHODS Retrospective study of 51 patients undergoing laparoscopic transperitoneal adrenalectomy in our department between March 2009 and June 2015. Of these, 25 (49%) were performed in the context of an imaging incidental finding of adrenal lesion and were the object of our study. We analyzed the histo-pathological findings and tried to gauge the real importance of size in distinguishing between benign and malignant lesions and if the 4cm recommended cut-off is suitable for surgical decision. RESULTS Most of the 25 analyzed patients women (60%) and the average age was 56 ± 3 years. Nine of incidental masses were located on the right (36%) and 16 on the left (64%) and the average size was 42 ± 5mm. All adrenalectomies were preceded by functional study, and 6 (24%) showed a subclinical hypersecretion (aldosterone - 33.3%, catecholamines - 50%; DHEA - 16.7%). The functioning masses had an average size of 37 ± 11mm. The nonfunctioning operated masses (76%) had an average size of 44 ± 5 mm. Overall, the pathological examination of the pieces revealed 11 adenomas (44%), 4 pheochromocytomas with benign features (16%), 3 carcinomas (12%) and 7 of other nature (28%). Regarding only nonfunctioning masses, there were 9 adenomas (47.4%), 2 benign pheochromocytoma (10.5%), 2 carcinomas (10.5%) and 6 of other nature (31.6%). Adenomas (31 ± 4mm) were significantly smaller than carcinomas (57 ± 13mm) - p 0.027. Eleven of the nonfunctioning incidental masses were larger than 40mm, and two of these were carcinomas (18.2%). None of the 8 masses with size < 40mm revealed no malignancy. These data translate into a sensitivity of 100% and a specificity of 47.1% for cancer detection using the 4cm cut-off size for nonfunctioning operated incidental adrenal masses. CONCLUSIONS The size of the incidental nonfunctioning lesions of the adrenal gland significantly influences the risk of malignancy and therefore the decision to perform surgical treatment. In our series, the usually recommended 4cm cut-off despite having a sensitivity for malignant lesions of 100%, showed a specificity of only 47.1%. Other features should be evaluated to try to increase specificity and reduce the excision of benign nonfunctioning lesions. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e126 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paulo Dinis More articles by this author Pedro Nunes More articles by this author Arnaldo Figueiredo More articles by this author Maria José Freire More articles by this author Mario Lourenço More articles by this author Belmiro Parada More articles by this author Alfredo Mota More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...