Likelihood Ratio of Computed Tomography Characteristics for Diagnosis of Malignancy in Adrenal Incidentaloma: Systematic Review and Meta-Analysis Publisher



Sabet FA¹ ; Majdzadeh R² ; Mostafazadeh Davani B³ ; Heidari K⁴ ; Soltani A³ Show Affiliations
Source: Journal of Diabetes and Metabolic Disorders Published:2016

Abstract

Purpose: 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 4cm 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 3cm threshold and positive and negative LR of 3.6 and 0.08 in 20HU density were resulted. Conclusion: The results retrieved in this study considering the limitations show that adrenal incidentaloma with a size less than 4cm or a mass larger than 4cm with density less than 10HU in the first group can be managed with imaging follow up. For masses larger than 4cm with density more than 10HU another diagnostic procedure should be performed. In the second group an adrenal mass larger than 3cm or less than 3cm with density more than 20HU should go under operation. But masses smaller than 3cm with less than 20HU density can be followed by imaging. © 2016 Sabet et al.