Allard P, Yankaskas B C, Fletcher R H, Parker L A, Halvorsen R A
Department of Epidemiology, School of Public Health, University of North Carolina Chapel Hill.
Cancer. 1990 Aug 1;66(3):457-62. doi: 10.1002/1097-0142(19900801)66:3<457::aid-cncr2820660310>3.0.co;2-r.
The ability of computed tomography (CT) to detect metastatic lesions in adrenal glands was evaluated on 91 autopsied lung cancer patients who died in 11 hospitals in the eastern United States and Canada from January 1983 to February 1988. Abdominal CT scans within 90 days of death were reviewed twice by two radiologists blinded to the autopsy diagnosis. The likelihood of metastatic spread in each adrenal gland was scored on a five-level scale. Histopathologic findings at autopsy were used to establish the presence or absence of metastases. The sensitivity of CT was low. Among 53 adrenal glands with proven metastatic lesions, the proportion with positive CT scans varied from 20.0% to 41.1%, according to the positivity threshold. In contrast, the specificity of CT was high, even at relaxed positivity thresholds, from 84.5% to 99.4%. The relatively low sensitivity of CT to detect adrenal metastatic lesions is explained to a large extent by the lack of substantial structural changes in many adrenal glands found to have metastases at autopsy. With a strongly positive CT scan, the probability of an adrenal metastatic lesion is high, and confirmatory adrenal biopsy may not be needed in patients with adenocarcinoma and large cell carcinoma.
对1983年1月至1988年2月期间在美国东部和加拿大11家医院死亡的91例肺癌尸检患者，评估了计算机断层扫描（CT）检测肾上腺转移瘤的能力。两名对尸检诊断不知情的放射科医生对死亡90天内的腹部CT扫描进行了两次复查。每个肾上腺转移扩散的可能性按五级评分。尸检时的组织病理学结果用于确定是否存在转移。CT的敏感性较低。在53个经证实有转移瘤的肾上腺中，根据阳性阈值，CT扫描阳性的比例在20.0%至41.1%之间。相比之下，CT的特异性较高，即使在放宽的阳性阈值下，也在84.5%至99.4%之间。CT检测肾上腺转移瘤的敏感性相对较低，很大程度上是因为在尸检中发现许多有转移的肾上腺没有明显的结构变化。CT扫描呈强阳性时，肾上腺转移瘤的可能性很高，腺癌和大细胞癌患者可能不需要进行肾上腺活检以确诊。
