Radiographic Characteristics of Adrenal Masses in Oncologic Patients Running title: Adrenal Masses in Oncologic Patients

We aimed to assess the usefulness of pre-contrast Hounsfield unit (HU) and mass size on computed tomography (CT) to differentiate adrenal mass found incidentally in oncologic patients.

From 2000 to 2012, 131 oncologic patients with adrenal incidentaloma (AI) were reviewed retrospectively.

Receiver operating characteristic (ROC) curves were applied to determine the optimal cut-off value of the mean HU and size for detecting adrenal metastasis.

The median age was 18 years, and 80 patients were male. The initial mass size was 18 mm, and 71 (54. 2%) of these were on the left side. A bilateral adrenal mass was found in 11 (8. 4%) patients. Biochemically functional masses were observed in 9. 2% of patients. Thirty-six out of 119 patients with nonfunctional masses underwent adrenalectomy, which revealed metastasis in 13. The primary cancers were lung cancer (n = 4), renal cell carcinoma (n = 2), lymphoma (n = 2), hepatocellular carcinoma (n = 2), breast cancer (n = 1), and others (n = 2). The area under the curve (AUC) for the size and HU for clinically suspicious metastasis were 0. 839 (95% CI, 0. 761-0. 900, p < 0. 001) and 0. 959 (95% CI, 0. 898-0. 988, p < 0. 001), respectively. The cut-off value to distinguish between metastasis and benign masses were 22 mm for size and 20 for HU.

ROC curve results suggest that pre-contrast HU >20 can be used as a diagnostic reference to suggest metastasis in oncologic patients with adrenal masses.

Endocrinology and metabolism (Seoul, Korea). 2015 Dec 09 [Epub ahead of print]

Ji Hyun Lee, Eun Ky Kim, A Ram Hong, Eun Roh, Jae Hyun Bae, Jung Hee Kim, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. , Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

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