title: Computed Tomography in the Management of Adrenal Tumors: Does Size Still Matter?
abstract: OBJECTIVE
  We sought to evaluate computed tomography (CT) imaging as a predictor of adrenal tumor pathology.
  
  
  METHODS
  A retrospective review was conducted of patients who underwent unilateral adrenalectomy for an adrenal mass between January 2005 and July 2015. Tumors were classified as benign, indeterminate, or malignant based on preoperative CT findings.
  
  
  RESULTS
  Of 697 patients who underwent unilateral adrenalectomy, 216 met the inclusion criteria. Pathology was benign in 88.4%, indeterminate in 2.3%, and malignant in 9.3%, with a median tumor diameter of 2.7 cm (interquartile range, 1.7-4.1 cm) and 9.5 cm (interquartile range, 7.1-12 cm) in the benign and malignant groups, respectively (P < 0.001). Of the tumors with benign features on CT, 100% (143/143) had benign final pathology.
  
  
  CONCLUSIONS
  Imaging characteristics of adrenal tumors on CT scan predict benign pathology 100% of the time. Regardless of size, when interpreted as benign on CT scan, laparoscopic adrenalectomy, if technically feasible, should be the technique used when surgery is offered, or close surveillance may be a safe alternative.
authors.affiliation: From the *Endocrine Surgery, Department of Surgery, and Departments of †Radiology and Radiological Sciences, ‡Oncology, and §Cellular and Molecular Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Saïd C
authors.initials: SC
authors.lastname: Azoury
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.forename: Allen
authors.initials: A
authors.lastname: Young
authors.forename: Aarti
authors.initials: A
authors.lastname: Mathur
authors.forename: Jason D
authors.initials: JD
authors.lastname: Prescott
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*