Management of endocrine disease: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis

Research output: Contribution to journalArticle

Standard

Harvard

APA

Vancouver

Author

Bibtex

@article{ee28465901534a32b3533d6f5bb84494,
title = "Management of endocrine disease: Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis ",
abstract = "Objective: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. Design: Systematic review and meta-analysis Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI or FDG-PET compared to an adequate histological or imaging-based follow-up reference standard. Results: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15) and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, i.e. masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. Conclusions: Despite its widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis. ",
keywords = "Imaging, adrenal mass, systematic review, diagnostic accuracy, adrenal malignancy",
author = "Jacqueline Dinnes and Irina Bancos and {Ferrante di Ruffano}, Lavinia and Vasileios Chortis and Clare Davenport and Susan Bayliss and Anju Sahdev and Peter Guest and Martin Fassnacht and Jonathan Deeks and Wiebke Arlt",
year = "2016",
month = aug,
day = "1",
doi = "10.1530/EJE-16-0461",
language = "English",
volume = "175",
pages = "R51--R64",
journal = "European Journal of Endocrinology",
issn = "0804-4643",
publisher = "BioScientifica",

}

RIS

TY - JOUR

T1 - Management of endocrine disease

T2 - Imaging for the diagnosis of malignancy in incidentally discovered adrenal masses: a systematic review and meta-analysis

AU - Dinnes, Jacqueline

AU - Bancos, Irina

AU - Ferrante di Ruffano, Lavinia

AU - Chortis, Vasileios

AU - Davenport, Clare

AU - Bayliss, Susan

AU - Sahdev, Anju

AU - Guest, Peter

AU - Fassnacht, Martin

AU - Deeks, Jonathan

AU - Arlt, Wiebke

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. Design: Systematic review and meta-analysis Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI or FDG-PET compared to an adequate histological or imaging-based follow-up reference standard. Results: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15) and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, i.e. masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. Conclusions: Despite its widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis.

AB - Objective: Adrenal masses are incidentally discovered in 5% of CT scans. In 2013/2014, 81 million CT examinations were undertaken in the USA and 5 million in the UK. However, uncertainty remains around the optimal imaging approach for diagnosing malignancy. We aimed to review the evidence on the accuracy of imaging tests for differentiating malignant from benign adrenal masses. Design: Systematic review and meta-analysis Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL Register of Controlled Trials, Science Citation Index, Conference Proceedings Citation Index, and ZETOC (January 1990 to August 2015). We included studies evaluating the accuracy of CT, MRI or FDG-PET compared to an adequate histological or imaging-based follow-up reference standard. Results: We identified 37 studies suitable for inclusion, after screening 5469 references and 525 full-text articles. Studies evaluated the accuracy of CT (n=16), MRI (n=15) and FDG-PET (n=9) and were generally small and at high or unclear risk of bias. Only 19 studies were eligible for meta-analysis. Limited data suggest that CT density >10HU has high sensitivity for detection of adrenal malignancy in participants with no prior indication for adrenal imaging, i.e. masses with ≤10HU are unlikely to be malignant. All other estimates of test performance are based on too small numbers. Conclusions: Despite its widespread use in routine assessment, there is insufficient evidence for the diagnostic value of individual imaging tests in distinguishing benign from malignant adrenal masses. Future research is urgently needed and should include prospective test validation studies for imaging and novel diagnostic approaches alongside detailed health economics analysis.

KW - Imaging

KW - adrenal mass

KW - systematic review

KW - diagnostic accuracy

KW - adrenal malignancy

U2 - 10.1530/EJE-16-0461

DO - 10.1530/EJE-16-0461

M3 - Article

VL - 175

SP - R51-R64

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

ER -