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Cited by 194Adrenal and Paraganglionic TumorsRenal cell carcinoma treatmentNeuroendocrine Tumor Research Advances

Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy?

Sturgeon, Cord, Shen, Wen T., Clark, Orlo H., Duh, Quan-Yang, Kebebew, Electron·2006·Journal of the American College of Surgeons
DOI 10.1016/j.jamcollsurg.2005.11.005
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Abstract

BACKGROUND: Laparoscopic adrenalectomy for tumors > 6 cm is controversial because of the risk of malignancy, but data to support this position are mostly from small series. The recent NIH consensus conference did not make a definitive recommendation about management of 4- to 6-cm nonfunctioning incidentalomas. STUDY DESIGN: Adrenocortical carcinomas (ACC) recorded in the Surveillance, Epidemiology, and End Results (SEER) database (1988 to 2000) were compared with benign functional or nonfunctional adrenal cortical adenomas (excluding aldosteronomas) operated on at our institution between January 1, 1993, and July 1, 2003. Data were compared using t-tests, chi-square tests, likelihood ratios, and receiver operating characteristic (ROC) curves. RESULTS: We identified 457 patients with ACC and 47 patients with adrenal cortical adenomas; 376 and 44 neoplasms, respectively, had tumor size data available. Tumor size was larger in ACC (12.0 +/- 5.6 versus 4.2 +/- 1.9 cm, mean +/- SD, p < 0.05). For ACC presenting with local disease, the sensitivity, specificity, and likelihood ratios of tumor size to predict malignancy were 96%, 52%, and 2.0, respectively, for tumors > or = 4 cm; 90%, 80%, and 4.4 for tumors > or = 6 cm; 77%, 95%, and 16.9 for tumors > or = 8 cm; and 55%, 98%, and 24.4 for tumors > or = 10 cm. Assuming a pretest probability of malignancy of 5%, the likelihood ratios derived from this study yield a posttest probability of 10%, 19%, and 47% for cancer in adrenal cortical tumors > or = 4 cm, > or = 6 cm, and > or = 8 cm, respectively. CONCLUSIONS: These data suggest that size is useful for predicting malignancy, and that at a size threshold of > or = 4 cm, the likelihood of malignancy doubles (to 10%) and it is more than ninefold higher for tumors > or = 8 cm (47%).

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  • The larger the mass, the higher the incidence of malignancy.

    “the realization that the larger the mass, the higher the incidence of malignancy (333)”

    From Adrenal incidentaloma (2020) · cites this paper as [333]

  • The risk for malignant adrenal tumors increases with tumor size, with sensitivity 97% and specificity 52% for tumors >4 cm and sensitivity 91% and specificity 80% for tumors >6 cm.

    “The risk for malignant adrenal tumors increases with tumor size, with the index of suspicion increasing for tumors >4 cm (sensitivity, 97%; specificity, 52%) and >6 cm (sensitivity, 91%; specificity, 80%) (89).”

    From Adrenocortical carcinoma (2014) · cites this paper as [89]

  • At the time of presentation, ACCs are generally large tumors, measuring on average 10 to 13 cm.

    “At the time of presentation, ACCs are generally large tumors, measuring on average 10 to 13 cm (9, 85, 89).”

    From Adrenocortical carcinoma (2014) · cites this paper as [89]

  • Only a minority of ACC tumors are <6 cm (9%-14%), with only 3% presenting as lesions <4 cm.

    “Only a minority of tumors are <6 cm (9%–14%), with only 3% presenting as lesions <4 cm (89, 90).”

    From Adrenocortical carcinoma (2014) · cites this paper as [89]

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Authors
Sturgeon, C., Shen, W. T., Clark, O. H., Duh, Q.-Y., & Kebebew, E.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
Journal of the American College of Surgeons
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-03
Volume
202
Issue
3
Pages
423-430
ISSN
1072-7515 (ISSN-L)
DOI
10.1016/j.jamcollsurg.2005.11.005
OpenAlex
W2053263151
Cited by
194
References
29
Citations by year
2026: 3 · 2025: 7 · 2024: 10 · 2023: 9 · 2022: 14 · 2021: 18 · 2020: 13 · 2019: 8 · 2018: 9 · 2017: 11 · 2016: 9 · 2015: 13 · 2014: 10 · 2013: 9 · 2012: 3
FWCI
10.41
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American College of Surgeons (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
  • Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
Keywords
adrenocortical carcinoma, adrenal adenoma, tumor size, malignancy prediction, incidental adrenal tumor, laparoscopic adrenalectomy, risk assessment, SEER database
MeSH terms
Adolescent, Adrenal Cortex Neoplasms, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Diagnosis, Differential, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Neoplasm Staging, Probability, Prognosis, Retrospective Studies, Severity of Illness Index, Prevalence, Adrenocortical Carcinoma, SEER Program, Risk Assessment

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