ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany
ENDOC Center for Endocrine TumorsAltonaer Street 59, 20357 Hamburg, GermanyDepartment of Internal MedicineUniversity of Hamburg, Hamburg, GermanyPraenobis HamburgHamburg, GermanyDepartment of RadiologyEndocrine and Diabetes UnitDepartment of Internal Medicine I, University HospitalComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, Germany.
Eur J Endocrinol. 2015 Apr;172(4):415-22. doi: 10.1530/EJE-14-0916. Epub 2015 Jan 19.
Thresholds of 2-20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs.
Retrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005-2010 was performed.
Tumor density was evaluated in unenhanced CT by two blinded investigators.
Median tumor size was 9 cm (range 2.0-20) for ACCs vs 4 cm (2.0-7.5) for BATs (P<0.0001). In ACCs, the median unenhanced HU value was 34 (range 14-74) in comparison with 5 (-13 to 40) in BATs (P<0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%.
This first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU >21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.
在未增强的计算机断层扫描（CT）中，建议使用 2-20 个亨氏单位（HU）的阈值来区分良性肾上腺肿瘤（BATs）和恶性肾上腺肿瘤。然而，这些研究仅包括少数肾上腺皮质癌（ACCs）。本研究通过纳入大量 ACC 患者来定义 HU 阈值。
回顾性、盲法、比较分析 2005-2010 年期间诊断的 51 例 ACC（30 例女性，中位年龄 49 岁）和 25 例 BAT（12 例女性，中位年龄 64 岁）患者的 CT 扫描。
两名盲法观察者评估未增强 CT 中的肿瘤密度。
ACC 的肿瘤大小中位数为 9cm（范围 2.0-20），BATs 的肿瘤大小中位数为 4cm（范围 2.0-7.5）（P<0.0001）。在 ACC 中，未增强 HU 值的中位数为 34（范围 14-74），而 BATs 的未增强 HU 值为 5（范围-13 至 40）（P<0.0001）。ROC 分析显示，HU 阈值为 21 时具有最佳的诊断准确性（敏感性 96%，特异性 80%，AUC 0.89）。然而，有两个 5cm 和 6cm 大小的 ACC 会被漏诊。将阈值设定为 13.9 可以达到 100%的敏感性，但特异性会降低至 68%。
本项关于 ACC 的首次大型研究证实，绝大多数 ACC 的未增强 HU 值>21。然而，为了避免误诊为良性肿瘤，应使用 13 的阈值。
