A Novel Scoring System to Correlate Preoperative Adrenal Imaging with Final Histology in Predicting Malignancy: A Retrospective Institutional Data Analysis
World Journal of Endocrine Surgery
and aim: To investigate whether preoperative contrast-enhanced computed tomography (CECT) will be able to differentiate benign adrenal mass from malignant mass by applying a combination of morphological criteria and correlating it with the final histopathology. Materials and methods: Thirty-six patients planned for surgery were assessed preoperatively with CECT abdomen and based on CT findings a score of 0 to 6 was given depending on the size of the lesion, margin, density,
... to surrounding structures, necrosis, and calcification which was further correlated with their final histopathology. Statistical test used: The reliability of the total score was checked using receiver operator characteristic (ROC) analysis. Results: Out of 36 patients, 28 were benign and 8 were malignant pathology. The presence of abutment, ill-defined margins, and necrosis on CT was found significantly more in patients with malignant pathology (p = 0.009, p = 0.005, and p = 0.009, respectively). The most sensitive and specific parameters in predicting malignancy based on CT were heterogeneity and ill-defined margins, respectively (100 and 94.6%, respectively). The cut-off score of four has a sensitivity, specificity, NPV, and PPV of 75, 82.1, 54.55, and 92%, respectively. The mean scores for benign and malignant were 2.21 ± 0.315 and 4.25 ± 1.581, respectively (p = 0.001). Conclusion: This novel scoring method including heterogeneity, margins, abutment, and necrosis plays a key role in predicting malignancy accurately on CT scans.