Likelihood ratio of computed tomography characteristics for diagnosis of malignancy in adrenal incidentaloma: systematic review and meta-analysis.
OBJECTIVE
To propose an evidence based diagnostic algorithm using mass characteristics to determine malignancy in patients with adrenal incidentaloma by CTscan.


METHODS
A systematic review in Medline, Scopus, relevant reference books and desk searching was performed up to January 2016 with relevant reference checking. The summery estimates of sensitivity, specificity, positive and negative likelihood ratio of different characteristics were calculated in two groups of the articles investigating the cases without previous malignancy and the articles investigating the oncologic cases.


RESULTS
Thirty six articles were included in this study. In the first group with no history of malignancy a positive and negative LR of 3.1 and 0.13 in 4 cm threshold and positive and negative LR of 2.85 and 0 in 10HU density were found. In the second group with history of malignancy positive and negative LR of 2.3 and 0.27 in 3 cm threshold and positive and negative LR of 3.6 and 0.08 in 20HU density were resulted.


CONCLUSIONS
The results retrieved in this study considering the limitations show that adrenal incidentaloma with a size less than 4 cm or a mass larger than 4 cm with density less than 10HU in the first group can be managed with imaging follow up. For masses larger than 4 cm with density more than 10HU another diagnostic procedure should be performed. In the second group an adrenal mass larger than 3 cm or less than 3 cm with density more than 20HU should go under operation. But masses smaller than 3 cm with less than 20HU density can be followed by imaging.
School of Medicine and Public Health, Evidence based Practice Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Fatemeh Alsadat
FA
Sabet
Center for Knowledge Translation and Exchange, Tehran University of Medical Sciences, School of Public Health, Tehran, Iran.
Reza
R
Majdzadeh
Evidence based Practice Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Babak
B
Mostafazadeh Davani
School of public health, Tehran University of Medical Sciences, Tehran, Iran.
Kazem
K
Heidari
Evidence based Practice Research Center, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Akbar
A
Soltani
Adrenal incidentaloma; HU Density; Likelihood ratio; Malignancy; Systematic review