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Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies.
[adrenal incidentaloma]
To
confirm
the
efficacy
of
preoperative
workup
,
the
authors
analyse
the
results
of
a
multicentre
study
in
a
surgical
series
of
patients
diagnosed
with
an
adrenal
incidentaloma
.
The
retrospective
review
of
a
prospectively
collected
database
was
conducted
.
The
data
was
obtained
by
six
surgical
units
operating
in
the
Campania
Region
,
Italy
.
Five
-
hundred
and
six
(
506
)
adrenalectomies
performed
between
1993
and
2011
on
498
patients
were
analysed
.
Final
histology
in
patients
with
a
preoperative
diagnosis
of
incidentaloma
and
studied
according
to
guidelines
(
230
/
282
patients
group
A
)
was
compared
with
final
histology
coming
from
patients
presenting
the
same
preoperative
diagnosis
but
studied
not
according
to
guidelines
(
52
/
282
patients
group
B
)
.
In
group
A
preoperative
diagnosis
was
confirmed
at
final
histology
in
76
/
81
(
93
.
8
%
)
cases
of
subclinical
functioning
lesions
presenting
as
an
incidentaloma
.
The
preoperative
detection
of
pheochromocytoma
and
primary
adrenocortical
cancer
(
ACC
)
reached
91
.
6
%
and
84
.
6
%
respectively
.
In
group
B
conversion
rate
to
open
surgery
was
higher
than
in
group
A
(
p
=
0
.
02
)
.
One
pheochromocytoma
was
missed
at
preoperative
diagnosis
whereas
one
ACC
smaller
than
4
centimetres
(
cm
)
and
coming
from
an
incidental
lesion
was
discovered
.
In
both
groups
a
significant
association
between
increasing
dimensions
of
incidentaloma
and
cancer
has
been
observed
(
p
=
0
.
001
)
.
This
surgical
series
confirm
the
high
efficacy
of
suggested
guidelines
.
A
significant
preoperative
detection
rate
of
adrenal
lesions
presenting
as
incidentaloma
is
observed
.
The
unnecessary
number
of
adrenalectomies
performed
in
understudied
patients
,
causing
higher
morbidity
,
was
not
associated
to
a
higher
detection
rate
of
primary
adrenocortical
cancer
.
