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MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis

OBJECTIVE: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the acc...

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Autores principales: Dinnes, Jacqueline, Bancos, Irina, Ferrante di Ruffano, Lavinia, Chortis, Vasileios, Davenport, Clare, Bayliss, Susan, Sahdev, Anju, Guest, Peter, Fassnacht, Martin, Deeks, Jonathan J, Arlt, Wiebke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065077/
https://www.ncbi.nlm.nih.gov/pubmed/27257145
http://dx.doi.org/10.1530/EJE-16-0461
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author Dinnes, Jacqueline
Bancos, Irina
Ferrante di Ruffano, Lavinia
Chortis, Vasileios
Davenport, Clare
Bayliss, Susan
Sahdev, Anju
Guest, Peter
Fassnacht, Martin
Deeks, Jonathan J
Arlt, Wiebke
author_facet Dinnes, Jacqueline
Bancos, Irina
Ferrante di Ruffano, Lavinia
Chortis, Vasileios
Davenport, Clare
Bayliss, Susan
Sahdev, Anju
Guest, Peter
Fassnacht, Martin
Deeks, Jonathan J
Arlt, Wiebke
author_sort Dinnes, Jacqueline
collection PubMed
description OBJECTIVE: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. DESIGN: A systematic review and meta-analysis was conducted. METHODS: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI, or (18)F-fluoro-deoxyglucose (FDG)-PET compared with an adequate histological or imaging-based follow-up reference standard. RESULTS: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15), and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, that is, masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. CONCLUSIONS: Despite their widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis.
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spelling pubmed-50650772016-10-17 MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis Dinnes, Jacqueline Bancos, Irina Ferrante di Ruffano, Lavinia Chortis, Vasileios Davenport, Clare Bayliss, Susan Sahdev, Anju Guest, Peter Fassnacht, Martin Deeks, Jonathan J Arlt, Wiebke Eur J Endocrinol Review OBJECTIVE: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. DESIGN: A systematic review and meta-analysis was conducted. METHODS: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI, or (18)F-fluoro-deoxyglucose (FDG)-PET compared with an adequate histological or imaging-based follow-up reference standard. RESULTS: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15), and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, that is, masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. CONCLUSIONS: Despite their widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis. Bioscientifica Ltd 2016-08-01 /pmc/articles/PMC5065077/ /pubmed/27257145 http://dx.doi.org/10.1530/EJE-16-0461 Text en © 2016 The authors http://creativecommons.org/licenses/by/3.0/ This work is licensed under a Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/)
spellingShingle Review
Dinnes, Jacqueline
Bancos, Irina
Ferrante di Ruffano, Lavinia
Chortis, Vasileios
Davenport, Clare
Bayliss, Susan
Sahdev, Anju
Guest, Peter
Fassnacht, Martin
Deeks, Jonathan J
Arlt, Wiebke
MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title_full MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title_fullStr MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title_full_unstemmed MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title_short MANAGEMENT OF ENDOCRINE DISEASE: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
title_sort management of endocrine disease: imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5065077/
https://www.ncbi.nlm.nih.gov/pubmed/27257145
http://dx.doi.org/10.1530/EJE-16-0461
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