Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Surg Oncol. 2024 Oct;56:102122. doi: 10.1016/j.suronc.2024.102122. Epub 2024 Aug 16.
Adrenal incidentalomas (AI) are predominantly nonfunctional and benign, and their detection and differential diagnosis are aided by computed tomography (CT). A nonfunctioning adrenal incidentaloma (NFAI) usually requires regular follow-up; however, adrenalectomy may be necessary in certain patients. This study aimed to evaluate prognostic predictors to guide the treatment approach for AIs.
This retrospective, single-center study involved patients diagnosed with NFAI from January 2000 to December 2020. Patients were divided into surgery and observation groups. A subgroup analysis compared malignant and benign adenoma within the surgery group.
A total of 307 patients were included, with 127 in the surgery group and 180 in the observation group. The surgery group displayed distinct morphological and malignant potential features in CT scans more frequently than the observational group did. The malignant subgroup exhibited more irregular borders on CT, and a higher number of patients with absolute washout under 60 % and relative washout under 40 % compared with the benign adenoma subgroup. Interestingly, within the surgery group, the mean tumor size was <4 cm for the both malignant and benign adenoma subgroups.
Characterizing NFAI is important for appropriate treatment, as not all AIs have a favorable prognosis. CT findings associated with malignant potential, such as Hounsfield unit and washout values, were useful in determining the need for surgical treatment. However, the conventional criterion of a 4-cm size threshold for surgery was not a reliable malignancy predictor. Surgical resection should be considered for specific patient groups to ensure proper treatment over mere observation.
肾上腺意外瘤（AI）主要是非功能性和良性的，计算机断层扫描（CT）有助于其检测和鉴别诊断。无功能性肾上腺意外瘤（NFAI）通常需要定期随访；然而，某些患者可能需要进行肾上腺切除术。本研究旨在评估预后预测因子，以指导 AI 的治疗方法。
这是一项回顾性的单中心研究，纳入了 2000 年 1 月至 2020 年 12 月期间诊断为 NFAI 的患者。患者分为手术组和观察组。亚组分析比较了手术组中恶性和良性腺瘤。
共纳入 307 例患者，其中手术组 127 例，观察组 180 例。手术组的 CT 扫描显示出更明显的形态和恶性潜在特征，而观察组则没有。恶性亚组在 CT 上显示出更不规则的边界，且有更多的患者绝对洗脱率<60%，相对洗脱率<40%，与良性腺瘤亚组相比。有趣的是，在手术组中，恶性和良性腺瘤亚组的平均肿瘤大小均<4cm。
对 NFAI 进行特征描述对于适当的治疗很重要，因为并非所有 AI 都有良好的预后。与恶性潜能相关的 CT 表现，如亨氏单位和洗脱值，有助于确定是否需要手术治疗。然而，4cm 大小作为手术阈值的传统标准并不是可靠的恶性预测因子。对于特定的患者群体，应考虑手术切除，以确保适当的治疗，而不仅仅是观察。
