Azienda Ospedaliero-Universitaria Careggi SOD 1 Chirurgia Generale, D'Urgenza e Mini-Invasiva, Florence, Italy.
J Surg Oncol. 2011 Apr;103(5):400-5. doi: 10.1002/jso.21843. Epub 2010 Dec 29.
In the management of adrenal lesions in oncological patients, many issues are still controversial: morphological signs of suspected malignancy, accuracy of imaging examinations, use of fine needle aspiration (FNA), and the role of laparoscopy. The present study attempts to address these questions through the evaluation of the management of adrenal metastases (AM) in a wide cohort of patients included in the Italian Register of Endoscopic Adrenal Surgery.
In January 2009, all patients recorded on the Register were evaluated, on the basis of CT scan, MRI, and FNA. The diagnostic, surgical, and follow-up data of 95 patients with pre-operative AM diagnosis have been reviewed. On the basis of the fulfilled criteria three patterns were identified: "diagnostic", "suspect," and "non-diagnostic."
CT scan sensitivity was 41.5%/77.9% and specificity was 54.5%/90.9% for "diagnostic"/"diagnostic" + "suspect" examinations, respectively. MRI sensitivity was 15.7%/78.9% and specificity was non-determinate/83.3% for "diagnostic"/"diagnostic" + "suspect" exams, respectively. Sensitivity of FNA was 33.3%. About surgery, conversions rate was 16.6%; no mortality or re-operations were reported; complications rate was 10.7%; and no relation was noted between tumor size and surgical outcome. Mean survival was 32 months; 5-year survival was 23%, independent of AM size; survival for lung AM was similar to that of breast and kidney AM.
Laparoscopy for AM, in expert hand, seems to be a feasible and oncologically safe approach. Due to the unsatisfactory diagnostic accuracy for AM, every oncological patient with suspect adrenal lesions should be encouraged to undergo this surgical procedure.
在肿瘤患者的肾上腺病变管理中，许多问题仍然存在争议：疑似恶性的形态学征象、影像学检查的准确性、细针穿刺（FNA）的应用以及腹腔镜的作用。本研究试图通过评估意大利内窥镜肾上腺手术登记处纳入的广泛患者队列中肾上腺转移（AM）的管理来解决这些问题。
2009 年 1 月，对登记处记录的所有患者进行评估，依据 CT 扫描、MRI 和 FNA。回顾了 95 例术前 AM 诊断患者的诊断、手术和随访数据。根据满足的标准，确定了三种模式：“诊断性”、“可疑性”和“非诊断性”。
CT 扫描的敏感性分别为 41.5%/77.9%，特异性分别为 54.5%/90.9%，用于“诊断性”/“诊断性”+“可疑性”检查。MRI 的敏感性分别为 15.7%/78.9%，特异性分别为非确定/83.3%，用于“诊断性”/“诊断性”+“可疑性”检查。FNA 的敏感性为 33.3%。关于手术，转化率为 16.6%；无死亡或再次手术；并发症发生率为 10.7%；肿瘤大小与手术结果之间无相关性。平均生存时间为 32 个月；5 年生存率为 23%，与 AM 大小无关；肺 AM 的生存率与乳腺和肾 AM 相似。
在经验丰富的医生手中，腹腔镜治疗 AM 似乎是一种可行且肿瘤安全的方法。由于 AM 的诊断准确性不令人满意，应鼓励每一位怀疑有肾上腺病变的肿瘤患者接受这种手术。
