[Discordance between actual and radiologically estimated size of an incidentaloma. Delay in questions regarding operative decision-making criteria].
OBJECTIVE
The accurate assessment of tumour size is an important consideration during preoperative evaluation of adrenal tumors, particularly incidentaloma; however the "size criteria" is still a controversial topic in some respects: size is a bad indicator of malignancy, there is still a confusion in the "grey zone" for tumors between 3 and 6 cm, and no universal consensus on the exact cut-off value for resection has been agreed. Nowadays it is clearly accepted that the "size criteria" alone is extremely limited in the assessment of adrenal tumor, moreover some studies suggested the relative inaccuracy of conventional CT in evaluating the size: radiological examination underestimated consistently adrenal tumor size. The aim of this study was to confirm those suggested data.


METHODS
Our study compared the radiological estimated size and the histological size of 26 incidentaloma operated on with a laparoscopic approach.


RESULTS
Our data confirm the inaccuracy of CT and MRI in predicting the size of incidentaloma particularly for tumor measuring less than 3 cm. CT and MRI significantly underestimated size of adrenal tumors, 108% for MRI and 101% for CT-scan.


CONCLUSIONS
The decision to operate, even with the advent and safety of laparoscopic adrenalectomy, cannot only rely on the "size criteria". Radiologists have to perform multiple 1 mm cuts until the very superior and inferior tip of this tumor in order to provide a better estimation of the size.
Defechereux
T
T
Service de chirurgie des glandes endocrines et transplantation, centre hospitalier universitaire de Liège, domaine universitaire du Sart-Tilman, B35 4000 Liège, Belgique. thierry.defechereux@caramail.com
Degauque
C
C
Hamoir
E
E
Lamberty
G
G
Preud'homme
L
L
Meurisse
M
M
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000886:Anthropometry; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed