title: Preoperative workup in the assessment of adrenal incidentalomas: outcome from 282 consecutive laparoscopic adrenalectomies.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: General and Emergency Surgery, "Federico II" University, Naples, Italy. mario.musella@unina.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Palma
authors.forename: Annunziato
authors.initials: A
authors.lastname: Tricarico
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
authors.forename: Antonietta
authors.initials: A
authors.lastname: Palazzo
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianco
authors.forename: Bernadette
authors.initials: B
authors.lastname: Biondi
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
mesh_terms: D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000175:diagnosis / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods / Q000706:statistics & numerical data; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007558:Italy; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult