Diagnosis of adrenal glands incidentaloma
Authors: Kutovoy O.B., Zhmurenko E.V., Kunyk L.V.
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In this study the results of examination and treatment of 91 patients with adrenal glands incidentaloma were analyzed. According to the results of the morphological study, adenomas were the most common (n=60). Among malignant tumors, ACC was detected in 7 patients, low and undifferentiated cancer – in 3 patients, sarcoma – in 2 patients and metastasis of cancer – in 4 patients. To assess the nature of the tumor, the following criteria were used: size and density according to CT. In 43 patients with neoplasms less than 4 cm in 9,3% of cases malignant adrenalomas occurred, at 4-6 cm (n=29) - in 17,2% of cases, more than 6 cm (n=19) - in 31,6%. In patients with ACC, 71,4% of tumors exceeded 6 cm, 28,5% - were within 4-6 cm, 14,1% - less than 4 cm. The frequency of detection of malignant incidentalomas increases in proportion to the growth of tumor size, and with a diameter of more than 4 cm it was 27,1%. Adrenal adenomas in 31.6% of cases were from 4 to 6 cm, and in 10% - more than 6 cm. Thus, the orientation only on the size of tumors did not provide enough convincing grounds for determining its malignant potential. High native density was noted in ACC (33.4±2.8 HU), ganglioneuroma (36.6 НU) and metastases of cancer (43.6±9.0 HU). Low density was found in adenomas (0.4±10.7 HU) and adrenal cysts (6.0±8.2 HU), p<0.05. The most informative method of investigation in adrenal incidentalomas was CT, with sensitivity in adenomas and cancers – 98,3% and 94,4% respectively, specificity – 82,4% and 84,6%.