title: Do additional imaging studies change operative management in patients undergoing adrenalectomy?
abstract: BACKGROUND
  The purpose of this study is to determine the incidence of a secondary imaging modality (SIM) in the workup of adrenal masses and the usefulness of this additional imaging in changing surgical management.
  
  
  METHODS
  A retrospective analysis of our adrenalectomy database was performed on adult patients who underwent ≥1 imaging study before surgery. A multivariate logistic regression model was then constructed to identify patient factors that predisposed SIM.
  
  
  RESULTS
  From February 2001 to August 2014, 264 cases met inclusion criteria, of which 98 (37%) were identified to have SIM. Patients with cancer (P = .001), incidentaloma (P = .002), and pheochromocytoma (P < .0001) were more likely to undergo additional imaging. MRI was the most commonly obtained SIM. In addition, 90 of the 98 cases (92%) met indications for adrenalectomy with primary imaging study and biochemical screening alone. Of the remaining 8 cases, in only 4 instances (4%) did SIM modify surgical decision making.
  
  
  CONCLUSIONS
  The high incidence of unnecessary additional imaging performed in patients undergoing adrenalectomy is counterproductive to efforts toward cost-conscious, high-quality health care. Patients with adrenal tumors would benefit from early surgical referral to allow the surgeon to help guide clinical decision making and to avoid the use of excessive imaging.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Irene
authors.initials: I
authors.lastname: Lou
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: herbchen@uab.edu.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D033162:Incidental Findings; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014922:Wisconsin; D055815:Young Adult