| Background:Adrenal incidentaloma(AI)means to the adrenal space occupying lesion incidentally discovered by imaging examination,usually does not cover the adrenal disease of typical clinical manifestations during the process at clinical diagnosis and treatment.In recent years,along with the development of ultrasonic B techniques and much attention has been paid to healthy checkup.The AI have an average detection rate of 4% with increasing accuracy of CT and MRI.Benign and nonfunctioning adrenal adenoma is made up about 70% of all the histopathological type that is originated from adrenal cortex or medulla.Functional adrenal incidentaloma is made up about 15% include hypercortisolism,primary hyperaldosteronism,pheochromocytoma.However,there are 10 percent of AI patients are malignant,and only 5% of adrenocortical carcinoma could be diagnosed in the early stage.Therefore,it is necessary to confirm malignancy and classification before surgery.The main treatment methods for AI are still opened or laparoscopic operations.But there is still lack of standard guidelines at home and abroad.Most patients of AI need further imaging examination,endocrine test and according to their clinical features,physical condition to decide whether operation or long-term follow up.Objective:According to the pathological result,analyze the clinical features,image features and endocrine markers of AI to summarize diagnostic value.To improve the diagnosis and treatment clinic level of AI by discussing the clinical safety and efficiency between open surgery and laparoscopy.Methods:Retrospectively analyze the clinical data of 78 patients with adrenal incidentalomas who having surgical treatment of in October,2011-October,2019 from urology department of The First Affiliated Hospital of Henan University.Clinical data were collected including age,gender,clinical and imaging features,endocrine test,tumor diameter,operation methods,operation duration,bleeding volume and pathologic results.The location diagnostic efficiency of ultrasonic B,CT and MRI should be compared between each other by using statistical methods of chi-square test.To discussion the diagnostic value of imaging examination,the diagnostic coincidence rate will be calculated when compared the result between imaging diagnosis and pathological diagnosis.Make a further discussion about the characteristics of CT plain scan and enhanced.The AI patients also needed to be divided into Functional and non-functional groups,to figure out the difference of diameter between two groups by using statistical methods of two independent sample t-test.The result of endocrine test about hypercortisolism,primary hyperaldosteronism and pheochromocytoma should be analyzed to confirm the effect on qualitative diagnostic of AI.Results:A total of 78 patients were included and treated surgically,involving 74 patients of benign AI and 4 patients of malignant AI.There are 56 as adrenal adenomas,5 as adrenocortical nodular hyperplasia,4 as adrenal cysts,2 as pheochromocytoma,2 as myelolipoma,1 as metastatic cancer,1 as adrenocortical adenocarcinoma,1 as sarcomatoid carcinoma,1 as malignant pheochromocytoma,1 as ganglioneuroma,1 as lipomyoma,1 as hemangioma,1 as lymphangioma,1 as macronodular adrenal hyperplasia.75 patients accepted Ultrasonic B,26 patients accepted MRI,and all of them accepted CT,which location diagnostic rate is 78.67%,100%,100%.Respectively significant difference(P<0.0167)is discovered when compared the Ultrasonic B with CT and MRI in location diagnostic rate.There is no significant difference between CT and MRI.Compared with pathologic results,the diagnostic rate of Ultrasonic B,CT and MRI is 80.3%,88.9%,84.6%,with no statistical significance.Analysis of Gemstone CT Plain and enhanced scans: The mean CT value in PHEO is higher than that in other AI(P<0.05).The average CT value of aldosterone adenoma is lower than that of other types of AI(P<0.05).The CT value of adrenocortical adenoma in arteriovenous phase is significantly higher than that of aldosterone adenoma(P<0.05).By ROC curve analysis,the sensitivity and specificity to separate the two type of AI is 100% if the CT values of plain scan,arterial phase and venous phase set at 15 Hu,45Hu,62 Hu.The adrenal cysts,lipomyoma,myelolipoma could be confirmed by CT before the surgery.The mean diameter of functional AI is 2.68±1.32 cm,while that of non-functional AI is 3.35±1.15 cm.No significant difference is found between the two groups(P<0.05).The patients is divided into the first 4-years group and after 4-years group.The average diameter of AI detected in the first 4-years group is 3.55±0.89 cm,while in after 4-years group is 3.09±1.01 cm.There is statistically significant difference between the two groups(P<0.05).Conclusion:1.Gemstone CT can provide more information about AI,adrenocortical adenoma presents mild to moderate enhancement in the arteriovenous phase,and the enhancement degree of cortisol adenoma is higher than aldosterone tumor;The CT value of PHEO was higher than that of AI 2.The results of adrenal endocrine of functional AI can be normal,which required further tumor morphology,density and CT value to diagnose.3.Due to the improvement of imaging technology and people's awareness for physical examination,the average diameter of AI is decreased compared with the previous.Functional AI and non-functional AI could not be effectively identified by diameter difference. |
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