E. Ajadi3, R. Randle1,4, J. Lee2, C. Lee1,4 1University Of Kentucky,Department Of Surgery,Lexington, KY, USA 2University Of Kentucky,Department Of Radiology,Lexington, KY, USA 3University Of Kentucky,College Of Medicine,Lexington, KY, USA 4University Of Kentucky,Division Of Endocrine Surgery,Lexington, KY, USA
Introduction:
Tumor size plays a major role in the recommended treatment approach for adrenal incidentalomas. We hypothesized that cross sectional imaging underestimates pathologic size for adrenal tumors and aimed to evaluate the ability of CT to accurately predict tumor size.
Methods:
We reviewed 115 consecutive adrenalectomies performed between 6/1/2011 and 5/31/2018 at a single institution. We excluded cases without preoperative CT imaging and those without accurate pathologic tumor measurements. A single abdominal radiologist independently reviewed all images and provided measurements of the adrenal mass in axial, coronal, and sagittal planes. Adrenal sizes noted on the original radiology report also were recorded.
Results:
113 patients formed the final cohort. The mean tumor size noted on final pathology was 5.4 cm compared to a mean independently measured largest CT size of 5.3 cm (p = 0.26). Of the independent measurements, the single largest CT size measurement was most correlated with pathology (r=0.95). The largest CT measurement on the original radiology report was also strongly correlated with final pathology (r=0.96). A mean original radiology report measurement of 5.2 cm was observed compared to 5.4 cm on final pathology (p = 0.003) thus lending some support to our original hypothesis. The greatest independently measured CT diameter overestimated the final tumor size in 55.3% (n=52) and underestimated the final tumor size in 34.7% (n=39). The longest independently measured CT diameter was most often measured in the axial plane (41%), followed by the sagittal plane (32%), and the coronal plane (30%).
Conclusion:
CT measurements are generally predictive of final tumor size. However, predicting whether a given CT dimension provides an overestimation or underestimation of final specimen size is challenging due to variations in reporting and planes measured. As size remains an important factor in management of adrenal incidentalomas, our findings highlight the predictive value of obtaining three-dimensional, multiplanar measurements and the need for further evaluation of methods to standardize measurement of adrenal tumors.