Preoperative Computed Tomography Imaging Accurately Identifies Adrenal Gland Involvement In Patients With Renal Masses.

OBJECTIVE

To determine the frequency of adrenal gland involvement (AGI) in patients with renal cell carcinoma (RCC) and assess the ability of preoperative computed tomography (CT) imaging to predict AGI prior to radical nephrectomy (RN).

METHODS

We retrospectively identified 90 patients who underwent RN with concomitant ipsilateral adrenalectomy (CIA) between 2019 and 2021 at our institution. We reviewed the preoperative CT findings and final pathology reports to assess AGI and determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative CT imaging.

RESULTS

Five patients (5.5%) had AGI on pathological analysis. On preoperative CT, 8 patients had CT findings suspicious of AGI. All 5 patients with pathological AGI were identified preoperatively yielding a sensitivity of 100%. Pathological analysis in all patients who did not demonstrate AGI on imaging showed no adrenal invasion, yielding a negative predictive value of 100%. High-grade tumors were significantly associated with AGI (84.4% vs 33.6%, P = .02). Patients with AGI had larger tumor size when compared with those without AGI on final pathology (10 cm vs 6.89 cm, P = .07).

CONCLUSION

The overall incidence of AGI in patients with RCC is low. Preoperative CT can accurately identify those with AGI and can thus prevent unnecessary CIA during RN.