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Distinguishing Benign from Malignant Euadrenal Masses

Milton D. Gross, MD; Brahm Shapiro, MB, ChB, PhD; J. Antonio Bouffard, MD; Gary M. Glazer, MD; Isaac R. Francis, MD; Gary P. Wilton, MD; Frederick Khafagi, MB, BS; and L. Paul Sonda, MD
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Grant Support: Partial support by grants R01-CA-43300-01, NCI CA-09015, NIAMDD R01-AM-2147702 RAD, and GCRC-HEW 3 M01 RR-0042-21SI CLR from the National Institutes of Health; and the Veterans Administration Research Service and the Nuclear Medicine Research Fund of The Division of Nuclear Medicine, The University of Michigan.

Requests for Reprints: Milton D. Gross, MD, Nuclear Medicine Service (115), Veterans Administration Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.

Current Author Addresses: Dr. Gross: Nuclear Medicine Service (115), Veterans Administration Medical Center, Ann Arbor, MI 48105.

Dr. Khafagi: Department of Nuclear Medicine, Royal Brisbane Hospital, Herston, Queensland 4029, Australia.

Drs. Bouffard, Francis, and Glazer: Department of Radiology; Dr. Sonda: Department of Surgery, Division of Urology; and Dr. Shapiro: Department of Internal Medicine; The University of Michigan Medical Center, Ann Arbor, MI 48109.

Dr. Wilton: Naples Radiologists, Naples, FL 33941-8089.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(8):613-618. doi:10.7326/0003-4819-109-8-613
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Study Objective: To determine the efficacy of 131I-6-beta-iodomethylnorcholesterol (NP-59) adrenal scintigraphy in distinguishing benign from malignant euadrenal masses.

Design: Case series of patients with incidentally discovered unilateral, euadrenal masses.

Setting: Referral-based nuclear medicine clinics at university and affiliated Veterans Administration medical centers.

Patients: Consecutive sample of 119 euadrenal patients with unilateral adrenal masses discovered on computed tomographic (CT) scans for reasons other than suspected adrenal disease.

Interventions: Adrenal scintiscans done using 1 mCi of NP-59 intravenously, and gamma camera imaging, 5 to 7 days later.

Measurements and Main Results: Mean lesion diameter was 3.3 ± 1.9 cm (SD) (95% CI: 2.9 to 3.6 cm). In 76 patients, NP-59 uptake lateralized to the abnormal adrenal seen on CT scans (concordant imaging), and in all of these patients, a diagnosis of adenoma was made by needle-aspiration biopsy, adrenalectomy, or extended follow-up with repeat CT scans that were unchanged at 6 months or later. Twenty-six patients had absent or markedly reduced NP-59 uptake in the glands identified as abnormal on CT scans (discordant imaging). These adrenal masses proved to be metastatic malignancies in 19 patients, primary adrenal neoplasms other than adenoma in 4, and adrenal cysts in 3. Bilateral, symmetric accumulation of NP-59 was seen in 17 patients, in whom the adrenal masses were shown to be metastatic malignancies in 2, and adenomas in 6 (the lesions in these cases being 2 cm or less in diameter), and lesions not truly involving the adrenal in the rest (periadrenal metastases in 4 and pseudoadrenal masses in 5). Sensitivity was 76% (26 of 34 patients; CI, 58% to 88%); specificity, 100% (85 of 85 patients; CI, 95% to 100%), and accuracy, 93% (111 of 119 patients; CI, 88% to 98%).

Conclusions: Functional NP-59 scintigraphy can be used to accurately and noninvasively characterize many euadrenal masses; concordance of CT and NP-59 scans can be used to exclude the presence of a malignancy or other space-occupying adrenal lesion.





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