title: A multi-center study on the surgical management of metastatic disease to adrenal glands.
abstract: BACKGROUND
  In the management of adrenal lesions in oncological patients, many issues are still controversial: morphological signs of suspected malignancy, accuracy of imaging examinations, use of fine needle aspiration (FNA), and the role of laparoscopy. The present study attempts to address these questions through the evaluation of the management of adrenal metastases (AM) in a wide cohort of patients included in the Italian Register of Endoscopic Adrenal Surgery.
  
  
  METHODS
  In January 2009, all patients recorded on the Register were evaluated, on the basis of CT scan, MRI, and FNA. The diagnostic, surgical, and follow-up data of 95 patients with pre-operative AM diagnosis have been reviewed. On the basis of the fulfilled criteria three patterns were identified: "diagnostic", "suspect," and "non-diagnostic."
  
  
  RESULTS
  CT scan sensitivity was 41.5%/77.9% and specificity was 54.5%/90.9% for "diagnostic"/"diagnostic" + "suspect" examinations, respectively. MRI sensitivity was 15.7%/78.9% and specificity was non-determinate/83.3% for "diagnostic"/"diagnostic" + "suspect" exams, respectively. Sensitivity of FNA was 33.3%. About surgery, conversions rate was 16.6%; no mortality or re-operations were reported; complications rate was 10.7%; and no relation was noted between tumor size and surgical outcome. Mean survival was 32 months; 5-year survival was 23%, independent of AM size; survival for lung AM was similar to that of breast and kidney AM.
  
  
  CONCLUSIONS
  Laparoscopy for AM, in expert hand, seems to be a feasible and oncologically safe approach. Due to the unsatisfactory diagnostic accuracy for AM, every oncological patient with suspect adrenal lesions should be encouraged to undergo this surgical procedure.
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi SOD 1 Chirurgia Generale, D'Urgenza e Mini-Invasiva, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Valeri
authors.forename: Carlo
authors.initials: C
authors.lastname: Bergamini
authors.forename: Fabiano
authors.initials: F
authors.lastname: Tozzi
authors.forename: Jacopo
authors.initials: J
authors.lastname: Martellucci
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Costanzo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Antonuzzo
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D044963:Biopsy, Fine-Needle; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome