Adrenal wash-out CT: moderate diagnostic value in distinguishing benign from malignant adrenal masses

Objective: Reliable results of wash-out CT in the diagnostic workup of adrenal incidentalomas are scarce. Thus, we evaluated the diagnostic accuracy of delayed wash-out CT and determined thresholds to accurately differentiate adrenal masses. Design: Retrospective, single-center cohort study including 216 patients with 252 adrenal lesions who underwent delayed wash-out CT. Definitive diagnoses based on histopathology (n=92) or comprehensive follow-up. Methods: Size, average attenuation values of the adrenal lesions in all CT scan phases, absolute and relative percentage washout (APW/RPW) were determined by an expert radiologist blinded for clinical data. Adrenal lesions with unenhanced attenuation values >10HU built a subgroup (n=142). Diagnostic accuracy were calculated. Results: The study group consisted of 171 adenomas, 32 other benign tumors, 11 pheochromocytomas, 9 adrenocortical carcinomas and 29 other malignant tumors. All (potentially) malignant and 46% of benign lesions showed unenhanced attenuation values >10HU. In this most relevant subgroup, the established thresholds of 60% for APW and 40% for RPW misclassified 35.9% and 35.2% of masses, respectively. When we applied optimized cutoffs (APW>83%; RPW>58%) and excluded pheochromocytomas, we missed only 1 malignant tumor by APW and none by RPW. However, only 11% and 15% of benign tumors were correctly identified. Conclusions: Washout CT with the established thresholds for APW und RPW is insufficient to reliably diagnose adrenal masses. Using the proposed cutoff of 58% for RPW, malignant tumors will be correctly identified, but the added value is limited, namely 15% of patients with benign tumors can be prevented from additional imaging or even unnecessary surgery.

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Laparoscopic Adrenalectomy for Potentially Malignant Adrenal Tumors Greater than 5 Centimeters

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2005-2420 ◽

2006 ◽

Vol 91 (8) ◽

pp. 3080-3083 ◽

Cited By ~ 61

Author(s):

Chun-Hou Liao ◽

Shih-Chieh Chueh ◽

Ming-Kuen Lai ◽

Po-Jen Hsiao ◽

Jun Chen

Keyword(s):

Tumor Size ◽

Laparoscopic Adrenalectomy ◽

Malignant Tumors ◽

Adrenal Tumors ◽

Benign Tumors ◽

Conversion To Open Surgery ◽

Open Conversion ◽

Potentially Malignant ◽

Adrenocortical Carcinomas

Abstract Purpose: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors. Patients and Methods: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. Results: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5–12 cm), operative time 207 min (115–315 min), and blood loss 75 ml (minimal–1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. Conclusions: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

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Value of 18-F-FDG PET/CT and CT in the Diagnosis of Indeterminate Adrenal Masses

International Journal of Endocrinology ◽

10.1155/2015/213875 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Nathalie Launay ◽

Stéphane Silvera ◽

Florence Tenenbaum ◽

Lionel Groussin ◽

Frédérique Tissier ◽

...

Keyword(s):

Fdg Pet ◽

Malignant Tumors ◽

Apparent Diffusion Coefficient Values ◽

Standardized Uptake Values ◽

Pet Ct ◽

Adrenal Masses ◽

18F Fdg ◽

Ct Data ◽

Adrenocortical Carcinomas ◽

Fdg Pet Ct

The purpose of this paper was to study the value of 18-FDG PET/CT and reassess the value of CT for the characterization of indeterminate adrenal masses. 66 patients with 67 indeterminate adrenal masses were included in our study. CT/MRI images and 18F-FDG PET/CT data were evaluated blindly for tumor morphology, enhancement features, apparent diffusion coefficient values, maximum standardized uptake values, and adrenal-to-liver maxSUV ratio. The study population comprised pathologically confirmed 16 adenomas, 19 metastases, and 32 adrenocortical carcinomas. Macroscopic fat was observed in 62.5% of the atypical adenomas at CT but not in malignant masses. On 18F-FDG PET/CT, SUVmax and adrenal-to-liver maxSUV ratio were significantly lower in adenomas than in malignant tumors. An SUVmax value of less than 3.7 or an adrenal-to-liver maxSUV ratio of less than 1.29 is highly predictive of benignity.

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Contrast Enhanced Mammography: The added value in the assessment of Suspicious Breast Lesions

QJM ◽

10.1093/qjmed/hcaa068.001a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

R Abdullah ◽

L Abdelmonem ◽

N Nasry ◽

M Ayoub

Keyword(s):

Breast Cancer ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Malignant Tumors ◽

High Energy ◽

Added Value ◽

Breast Lesions ◽

Predictive Values ◽

Dense Breasts ◽

Contrast Enhanced

Abstract Background Breast cancer in women is a major public health problem throughout the world, being the second most common cancer worldwide. Sonomammography has been always recommended as the basic breast imaging modality for early detection and diagnosis of breast cancer. Some malignant tumors have been missed, specially in dense breasts, and high false-negative rate have been reported. Contrast enhanced spectral mammography is a new modality, used to depict the tumor vascularity and neoangiogenesis; a classic sign of malignant tumors. Aim of Work The purpose of this study is to determine the added value of dual energy contrast mammography to sono-mammography in the assessment of suspicious breast lesions. Patients and Methods 36 patients were included in the study, referred from outpatient clinics in private settings and from Demerdash Hospitals. Contrast enhanced spectral mammography CESM was performed by using a digital mammography unit (Seno DS; GE, Buc, France) that had been adapted to obtain two images for each view: a low-energy image (below the k edge of iodine, 33.2 keV) and a high-energy image (above the k edge of iodine) at 45 to 49 kVp. Results: CEDM versus sonomammography shows p (0.021) value less than 0.05. Also the area under the ROC curve was higher for MX+CEDM (94.4%) than that was for sonomammography (63.8%) compared to pathology analysis with 100% sensitivity, 88.2 % specificity, 90.48 %PPV and 100 % NPV in diagnosis of suspicious lesions. Conclusion The diagnostic accuracy of CEDM+ MX for the detection of breast carcinoma has proven to be superior to sonomammography alone. CEDM had a better diagnostic accuracy mainly due to improved positive and negative predictive values (Positive predictive value about 90.48, negative predictive value 100). The role of CEDM in detection of multifocal / multicentric carcinomas with particular interest for the assessment of the extent of disease specially in dense breasts is appreciated.

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Minimally Invasive Surgery for Pediatric Adrenal Masses—Report on Four Cases

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0039-1694058 ◽

2019 ◽

Vol 07 (01) ◽

pp. e75-e78 ◽

Cited By ~ 1

Author(s):

Ahmed ElHaddad ◽

Christoph Castellani ◽

Erich Sorantin ◽

Martin Benesch ◽

Eva Kampelmühler ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Malignant Tumors ◽

Adrenocortical Tumor ◽

Patient Case ◽

Simple Cyst ◽

Potentially Malignant ◽

Adrenal Masses

AbstractThe dignity of adrenal masses in children varies from benign lesions like adenoma and ganglioneuroma to malignant tumors like adrenocortical carcinoma and neuroblastoma. Any surgical approach, especially minimally invasive surgery (MIS), requires careful risk stratification based on oncological and technical criteria. Herein, we present four patients who underwent MIS for adrenal masses. Laboratory testing differentiated between simple cysts and adenoma, but could not identify a child with adrenocortical tumor preoperatively. Analysis of image-defined risk factors excluded vascular encasement in all cases. All patients underwent laparoscopic adrenalectomy without complications. Histopathology revealed simple cyst, ganglioneuroblastoma, adenoma, and potentially malignant adrenocortical tumor in one patient/case each. All specimen showed clear margins and no recurrence was noted at a mean follow-up of 18 months.

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Study on the Effect of MRI in the Diagnosis of Benign and Malignant Thoracic Tumors

Disease Markers ◽

10.1155/2021/3265561 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yan Li ◽

Yangli Sui ◽

Mingyan Chi ◽

Jie Zhang ◽

Lin Guo

Keyword(s):

Malignant Tumors ◽

Compliance Rate ◽

Breast Tumors ◽

Diagnostic Value ◽

Diagnostic Sensitivity ◽

Good Effect ◽

Benign Tumors ◽

Mediastinal Tumors ◽

Chest Wall Tumors ◽

Diagnostic Sensitivity And Specificity

In order to investigate the effectiveness and accuracy of magnetic resonance imaging (MRI) in the diagnosis of benign and malignant thoracic tumors, the research retrospectively selected 80 patients with thoracic tumors admitted from May 2019 to May 2020 as the study subject and all patients were underwent MRI detection. Using pathological diagnostic results as the gold standard, the research analyzed the detection of benign and malignant thoracic tumors by MRI, as well as the diagnostic sensitivity and specificity. After pathological diagnosis, there were 35 malignant tumors and 45 benign tumors. 41 cases of malignant tumors and 39 cases of benign tumors were diagnosed by MRI, with a diagnostic sensitivity of 80.00%, a diagnostic specificity of 71.11%, and a diagnostic compliance rate of 75.00%. In the MRI diagnosis of tumors in different parts of the chest, the diagnostic sensitivity for lung tumors, mediastinal tumors, chest wall tumors, and esophageal tumors was 83.33%, 71.43%, 83.33%, 75.00%, and 87.50%, respectively, and the specificity was 66.67%, 77.78%, 57.14%, 50.00%, and 91.67% according to and breast tumors, respectively. And the accuracy was 73.33%, 75.00%, 69.23, 62.50%, and 90.00%, respectively, with the highest diagnostic sensitivity, specificity, and accuracy for breast tumors. MRI has a good effect on the diagnosis of benign and malignant thoracic tumors and has a high diagnostic value, which is helpful to identify the location, nature, source, and lesion scope of the tumor. It is safe and worthy of promotion.

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Evaluation of salivary gland tumors- clinically radiologically and pathologically: prospective study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211178 ◽

2021 ◽

Vol 7 (4) ◽

pp. 575

Author(s):

Namita Mishra ◽

Neeta Sharma

Keyword(s):

Salivary Gland ◽

Diagnostic Accuracy ◽

Clinical Presentation ◽

Malignant Tumors ◽

Needle Aspiration ◽

Salivary Gland Tumors ◽

Benign Tumors ◽

Aspiration Cytology ◽

Fine Needle ◽

Needle Aspiration Cytology

Background: Salivary gland tumors are difficult to differentiate based solely on clinical presentation or cytological findings due to their overlapping pictures. Often inadequate samples from cytology pose a challenge in preoperative diagnosis. Histopathology is considered the gold standard in diagnosing these tumors. The purpose of this study was to determine clinical, radiological, and cytological findings of these tumors and to assess the accuracy of these results with that of histopathological diagnosis.Methods: Prospectively 52 patients with salivary gland swellings were enrolled between 2007-2009. Cases with inflammatory swelling were excluded from the study. Demographic, clinical history, preoperatively ultrasonography, cytology, and histopathological data were collected and analyzed.Results: Most cases (65.38%) had parotid gland involvement. Benign tumors were common (80.76%) with pleomorphic adenoma as the most common one. Malignant tumors comprised 19.23%. Mucoepidermoid carcinoma and adenoid cystic carcinoma were common malignant tumors. Local swelling was the most common clinical presentation, and no facial nerve involvement was reported. The hard palate was the most common minor salivary gland affected predominantly by benign tumors. The diagnostic accuracy of fine-needle aspiration cytology was 96.15%, followed by clinical and radiological diagnostic accuracy of 92.31% and 86.54%, respectively. Using McNemar's test, a significant agreement was found between clinical and histological diagnosis (p=0.1336) and between FNAC and histological diagnosis (p=0.4975).Conclusions: Fine needle aspiration cytology is a highly accurate, sensitive, and specific screening technique. It is safe and reliable, though minimally invasive. Ultrasonography-guided cytology along with clinical, and radiological findings could enhance the pre-operative diagnostic accuracy in distinguishing salivary gland tumors.

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DIAGNOSTIC VALUE OF OPHTHALMOLOGICAL INVESTIGATION IN PATIENTS WITH BRAIN TUMORS

Likarska sprava ◽

10.31640/jvd.3-4.2020(6) ◽

2020 ◽

pp. 36-41

Author(s):

Keneshbek Yrysov ◽

Mitalip Mamytov ◽

Eliza Alik kyzy

Keyword(s):

Visual Acuity ◽

Brain Tumors ◽

Optic Disc ◽

Malignant Tumors ◽

Diagnostic Value ◽

Benign Tumors ◽

Benign Intracranial Hypertension ◽

Kyrgyz Republic ◽

Visual Disorders ◽

The Brain

The objective of the work was an accentuation of clinical appearances of pathogenesis of congestive optic disc as a basis for improving their diagnosis. Material and methods. This work based on the analysis of ophthalmological symptoms in 169 patients with brain tumors that underwent neurosurgical tumor surgery at Neurosurgical Clinic of National Hospital (Ministry of Health of the Kyrgyz Republic) from 2014 to 2019. Patient’s age varied from 14 years to 67 years old, medium age was 34 years. The number of male was 63, and the number of female was 106. All patients were examined by using neurological investigation, MRI of the brain before surgery and MRI/CT after surgery. Benign tumors have been identified in 56 patients and malignant tumors in 50 patients. Glial brain tumors identified in most cases (49 patients). Results. We could investigate visual function of 55 (93 %) patients out of 169 patients with congestive optic disc caused by large appearances in the brain. 46 (27.4 %) of patients out of 169 had reduced visual acuity caused by congestive optic disc. Meanwhile 22 (13.1 %) patients had acuity in both eyes by 1.0; 6 (3.3 %) patients had a blind or a partially blind eye, whereas the reduction of visual acuity was in another eye; additionally 7 (4 %) patients were blind or nearly blind in both eyes. Conclusion. The frequency and severity of visual disorders in congestive optic disc depend on the congestive optic disc stages. The stage of severe congestive optic disc and other already existing visual disorders are prognostically unfavorable for visual functions of patients with congestive optic disc. The terms of congestive optic disc regression depend on the methods of treatment. Congestive optic disc regression is occurring slowly (from 1 month to 3 years) when the medicamental therapy is used for patients with benign intracranial hypertension. Surgical or bypass removal of the large appearance of liquor system of congestive optic disc regression is much faster (1 to 1.5 months).

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Comment on “The diagnostic value of D-dimer with simplified Geneva score (SGS) pre-test in the diagnosis of pulmonary embolism (PE)”

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01301-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Siamak Sabour

Keyword(s):

Pulmonary Embolism ◽

Clinical Practice ◽

Diagnostic Accuracy ◽

Diagnostic Test ◽

Diagnostic Value ◽

Added Value ◽

Diagnostic Model ◽

Test Results ◽

Single Test ◽

D Dimer

Abstract Any decision in clinical practice needs to evaluate both reliability (precision) and validity (accuracy) of a diagnostic test. Without knowledge about the reliability, any judgment would be wrong. In diagnostic accuracy research, it is essential to evaluate the diagnostic added value of a test, since a diagnostic accuracy of a single test might be excellent, however for clinical purposes it can be worthless. Like evaluating discrimination, it would be possible to estimate the diagnostic added value by applying ROC of diagnostic model with and without test results in the model.

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Diagnostic Accuracy of Xeromammography

Tumori Journal ◽

10.1177/030089168106700510 ◽

1981 ◽

Vol 67 (5) ◽

pp. 447-453 ◽

Cited By ~ 1

Author(s):

Valter Castiglione ◽

Adelaide D'Antona ◽

Luigi Dellafiore ◽

Luisa Ferrario ◽

Guido Luzzatti ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Malignant Tumors ◽

Age Groups ◽

Disease Process ◽

Diagnostic Errors ◽

Benign Tumors ◽

Radiologic Investigation ◽

Pathologic Processes ◽

Sclerosing Adenosis

The analytical study of the case material has allowed a precise evaluation of the distribution by age groups of the different pathologic processes of the breast, of the localization and dimensions of malignant tumors, as well as the diagnostic accuracy for those cases histologically ascertained and those with a follow-up. The diagnostic accuracy and the consequent reliability of the xeroradiographic method for the diagnosis of breast cancer is distinctly superior to that reported in the literature for traditional mammography, whereas for the differential diagnosis between circumscribed dysplastic manifestations and benign tumors xeromammography is not sufficiently reliable. The authors critically discuss the results and in particular the problem of false positives, which also include diagnostic errors that cannot be avoided in that they directly derive from the pathologic morphology of the disease process (plasma cell mastitis and sclerosing adenosis). As regards the problem of false negatives, they can be reduced within certain limits by resorting to other instrumental investigations. However, there are cases (1% of the malignant neoplasias histologically ascertained) that present a completely negative xeroradiographic finding. These are the limits of the radiologic investigation which cannot in any way be surmounted.

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Nasal septal pediculate carcinoma in situ: differential diagnosis

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000400004 ◽

1996 ◽

Vol 114 (4) ◽

pp. 1216-1219

Author(s):

Edmir Américo Lourenço ◽

Luís Henrique Chechinato Costa

Keyword(s):

Differential Diagnosis ◽

Female Patient ◽

Carcinoma In Situ ◽

Malignant Tumors ◽

Daily Practice ◽

Wood Dust ◽

Benign Tumors ◽

Potentially Malignant ◽

Malignant Lesions

Pediculated lesions of the nasal cavities are relatively common in daily practice, and include inflammatory polyps, benign tumors (papillomas being the most common), malignant tumors, and specific processes, such as polypoid rhinosporidiosis. The authors describe a female patient with a warty, pediculated, and asymptomatic lesion in the nasal septal mucosa. The anatomo-pathological exam showed this to be a"carcinoma in situ." The few bibliographic citations report only an association between the tumor and contact with wood dust, such as oak, ebony and beech. The patient was not exposed to these elements. It is important to emphasize the routine performance of a complete otolaryngological exam for patients seeking out specialists, in order to detect potentially malignant lesions whose early removal would permit a complete cure.

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