title: Preoperative cross-sectional imaging allows for avoidance of unnecessary adrenalectomy during RCC surgery.
abstract: OBJECTIVE
  To assess the frequency of adrenal involvement and the reliability of preoperative imaging to predict adrenal involvement in patients treated for cortical renal masses at a single institution.
  
  
  METHODS
  Using a retrospective pathology database, we identified 117 consecutive patients who underwent radical nephrectomy and concomitant ipsilateral adrenalectomy at our institution over the course of 2 decades. Patient demographics, tumor characteristics, and radiographic results were obtained for analysis.
  
  
  RESULTS
  Of 117 patients, only 6 (5.1%) were identified as having adrenal involvement. The average age of the patient was 58.3 years, and the average tumor size was 7.13 cm. The mean tumor size in patients without adrenal involvement was 6.79 cm, whereas in those with adrenal involvement, it was 9.62 cm (P = 0.057). Of 6 patients with adrenal involvement, 5 had imaging studies available for review, and all 5 demonstrated suspicion for adrenal involvement preoperatively. Among 111 patients without adrenal involvement, 53 (47.7%) had imaging available for review, with only 3 (5.7%) demonstrating suspicion for adrenal involvement. The negative predictive value was 100%, whereas the sensitivity and specificity were 100% and 94.3%, respectively.
  
  
  CONCLUSIONS
  Ipsilateral adrenal involvement in renal cell carcinoma is uncommon and reliably predicted by preoperative cross-sectional imaging. Among all adrenalectomies in this series, nearly 95% were performed unnecessarily. With careful review, preoperative imaging can help avoid unnecessary adrenalectomy during radical nephrectomy in patients with renal cortical tumors.
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Stephen
authors.initials: S
authors.lastname: Blakely
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY. Electronic address: bratslag@upstate.edu.
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Osama
authors.initials: O
authors.lastname: Zaytoun
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Mickey
authors.initials: M
authors.lastname: Daugherty
authors.affiliation: Department of Pathology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Landas
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Oleg
authors.initials: O
authors.lastname: Shapiro
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D000315:Adrenalectomy; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Adrenal preservation; Adrenalectomy; Radical nephrectomy; Renal cell carcinoma