title: Minor morphologic abnormalities of adrenal glands at CT: prognostic importance in patients with lung cancer.
abstract: OBJECTIVE
  To determine the prognostic importance of minor morphologic abnormalities of the adrenal glands at computed tomography (CT) in patients with lung cancer.
  
  
  METHODS
  The study was approved by the committee on human research; written informed consent was not required. The authors retrospectively identified 197 patients with lung cancer who underwent serial chest or abdominal CT and did not have a focal adrenal mass at baseline CT. Two readers independently classified the morphologic features of each adrenal gland as normal, smoothly enlarged, or nodular at initial CT examination. They separately recorded the presence or absence of metastases to the adrenal glands (ie, any new focal adrenal mass) at final CT examination; a third independent reader arbitrated when interpretations were discordant (n = 11). Multivariate Cox proportional hazard models were used to assess for associations between baseline adrenal gland morphologic features and subsequent development of adrenal metastases.
  
  
  RESULTS
  At initial CT, reader 1 classified 253 (64%), 70 (18%), and 71 (18%) of the 394 adrenal glands and reader 2 classified 258 (65%), 45 (11%), and 91 (23%) of these glands as normal, smoothly enlarged, or nodular, respectively. The readers had moderate interobserver agreement regarding the classification of adrenal gland morphologic features (kappa = 0.54). Metastases subsequently developed in 13 adrenal glands in 11 patients. Cox proportional hazard models revealed no significant association between baseline adrenal gland morphologic features and subsequent development of adrenal metastases (P = .50 and P = .20 for readers 1 and 2, respectively).
  
  
  CONCLUSIONS
  In patients with lung cancer, smooth enlargement or nodularity of the adrenal glands at baseline CT is not associated with increased risk of subsequently developing adrenal metastases.
authors.affiliation: Department of Radiology, University of California-San Francisco, Box 0628, M-372, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Benitah
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Yeh
authors.forename: Aliya
authors.initials: A
authors.lastname: Qayyum
authors.forename: Gethin
authors.initials: G
authors.lastname: Williams
authors.forename: Richard S
authors.initials: RS
authors.lastname: Breiman
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D015588:Observer Variation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*