A. E. Hamilton1, G. A. Taylor1, R. L. Green1, T. P. Gao1, L. E. Kuo1 1Temple University, Department Of Surgery, Philadelpha, PA, USA
Introduction:
The majority of incidentally discovered adrenal masses are not appropriately evaluated. Previous studies show that the language used in radiology reports influences how findings are addressed by clinicians. This study aims to evaluate the impact of reporting Hounsfield units (HU) on the follow-up of adrenal incidentalomas.
Methods:
Medical records were reviewed for all patients with an adrenal incidentaloma identified on a CT scan from 2015-2020 at our tertiary care institution. Patients were included if the scan was performed without contrast. Chart review was conducted to distinguish whether Hounsfield units (HU) were reported. Patient demographics, CT scan characteristics, documentation, and follow up care for the adrenal incidentaloma were compared between patients who had HU reported and those who did not.
Results:
415 patients with adrenal incidentalomas identified on non-contrast CT scans were studied, 37 (8.9%) of whom had HU reported. There were no statistically significant differences in patient demographics or comorbidities between patients who did versus did not have HU reported. Those with HU reported were more likely to have their adrenal lesion noted in their past medical history (5(13.3%) vs. 14(4.6%), p=0.04) and to be referred to a specialist (10(27.0%) vs. 40(10.7%), p=0.01). Patients with HU reported had fewer abdominal scans prior to seeing a specialist or initiation of biochemical workup than those without HU reported (median 1 (interquartile range [IQR] 1-1.5) versus 1 (1-2), p=0.02). Patients with HU reported were more likely to have biochemical evaluations performed (see Table). Patients with HU reported were more likely to complete an evaluation and have an associated diagnosis (5(13.5%) vs. 20(5.2%), p<0.01).
Conclusion:
Recording HU of adrenal incidentaloma on non-contrast CT scans positively impacts follow-up care. Patients were more likely to be referred for follow-up care, have it noted in the past medical history, have a biochemical evaluation and carry a diagnosis when HU were reported. Increased reporting of HU for adrenal incidentalomas seen on non-contrast CT scans may improve rates of appropriate evaluation.
