Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer: Impact of magnetic resonance imaging Journal Article


Authors: Burt, M.; Heelan, R. T.; Coit, D.; McCormack, P. M.; Bains, M. S.; Martini, N.; Rusch, V.; Ginsberg, R. J.
Article Title: Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer: Impact of magnetic resonance imaging
Abstract: We designed a prospective study to evaluate the accuracy of magnetic resonance imaging in distinguishing a benign from a malignant adrenal mass in patients with otherwise operable non-small-cell lung cancer. Methods: Potentially operable non-small-cell lung cancer was prospectively staged. If a unilateral adrenal mass was found by computed tomographic scanning, respiratory compensated and cardiac gated thin section magnetic resonance imaging of the adrenal glands was done. One radiologist interpreted the magnetic resonance imaging scan blinded and, on the basis of the relative signal strengths of the T1- and T2-weighted images, judged whether the adrenal mass was benign or malignant. The patients then underwent a percutaneous needle biopsy of the adrenal mass, if technically feasible. If the result of the needle biopsy was nondiagnostic or if the biopsy was not feasible, an adrenalectomy through a posterior approach was performed. Results: Twenty-seven patients with a unilateral adrenal mass entered the study—11 men and 16 women whose ages ranged from 42 to 75 years (median 58 years). Four patients had epidermoid and 23 adenocarcinoma of the lung. The clinical locoregional stage was I in 9, II in 1, IIIA in 16, and IIIB in 1. Twenty-five completed the magnetic resonance imaging procedure. Five adrenal masses (19%) were metastatic non-small-cell lung cancer (adenocarcinoma = 4, epidermoid = 1); 22 masses (81 %) were benign (adenoma = 20, hyperplasia = 2). There were no significant differences in age, sex, histologic type, or locoregional stage between those with a benign versus a malignant mass. However, the malignant masses were significantly larger (3.8 ± 1.9 cm; range 2.5 to 7.1; median 3.1) than the benign masses (2.0 ± 0.4 cm, range 1.2 to 2.8; median 2.0) (p < 0.001). Among those having magnetic resonance imaging (n = 25), the technique correctly predicted a malignant mass in the four patients with a histologically confirmed metastasis from non-small-cell lung cancer. However, among the 21 histologically benign masses, the magnetic resonance imaging was interpreted as benign in 5, malignant in 14, and indeterminate in 2. Therefore, although the false-negative rate was 0 %, the false-positive rate was 67%. Conclusion: Most adrenal masses in patients with otherwise operable non-small-cell lung cancer are benign. Currently available magnetic resonance imaging methods cannot replace biopsy. © 1994, Mosby-Year Inc. All rights reserved.. All rights reserved.
Keywords: adult; clinical article; human tissue; aged; survival analysis; clinical trial; nuclear magnetic resonance imaging; magnetic resonance imaging; neoplasm staging; diagnostic accuracy; prospective study; sensitivity and specificity; prospective studies; computer assisted tomography; diagnosis, differential; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; biopsy, needle; needle biopsy; predictive value of tests; malignant neoplastic disease; benign tumor; adrenal tumor; adrenal gland neoplasms; adrenal metastasis; middle age; adrenal glands; adrenal gland diseases; human; male; female; priority journal; article
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 107
Issue: 2
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 1994-02-01
Start Page: 584
End Page: 589
Language: English
DOI: 10.1016/s0022-5223(94)70106-7
PROVIDER: scopus
PUBMED: 8302078
DOI/URL:
Notes: Export Date: 14 January 2019 -- Article -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Valerie W Rusch
    865 Rusch
  2. Robert J Ginsberg
    178 Ginsberg
  3. Daniel Coit
    542 Coit
  4. Manjit S Bains
    338 Bains
  5. Robert T Heelan
    140 Heelan
  6. Nael   Martini
    105 Martini
  7. Michael E. Burt
    187 Burt