Stephan Petersenn1, Paul-Ajoy Richter2, Thomas Broemel2, Christian O Ritter2, Timo Deutschbein2, Frank-Ulrich Beil2, Bruno Allolio2, Martin Fassnacht3. 1. 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 stephan.petersenn@endoc-med.de. 2. 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. 3. 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.
Abstract
OBJECTIVE: 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. DESIGN: 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. METHODS: Tumor density was evaluated in unenhanced CT by two blinded investigators. RESULTS: 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%. CONCLUSIONS: 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.
OBJECTIVE: 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. DESIGN: 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. METHODS:Tumor density was evaluated in unenhanced CT by two blinded investigators. RESULTS: 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%. CONCLUSIONS: 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.
Authors: A Stigliano; I Chiodini; R Giordano; A Faggiano; L Canu; S Della Casa; P Loli; M Luconi; F Mantero; M Terzolo Journal: J Endocrinol Invest Date: 2015-07-14 Impact factor: 4.256
Authors: Filip Ctvrtlik; Zbynek Tudos; Paulina Szasz; Zuzana Sedlackova; Igor Hartmann; Jan Schovanek; Zdenek Frysak; Iva Macova; Tomas Zelinka; Milan Hora; Eva Kocova; Jaroslav Pacovsky; Michal Krsek; Viera Lehotska; Emilia Mojtova; Josef Molnar; Vladimir Vanek; Karel Pacak; Jan Baxa Journal: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Date: 2019-09-23 Impact factor: 1.245
Authors: Wiebke Schloetelburg; Ines Ebert; Bernhard Petritsch; Andreas Max Weng; Ulrich Dischinger; Stefan Kircher; Andreas Konrad Buck; Thorsten Alexander Bley; Timo Deutschbein; Martin Fassnacht Journal: Eur J Endocrinol Date: 2021-12-10 Impact factor: 6.664