Preoperative Imaging May Avert Unnecessary Adrenalectomy

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ATLANTA—Preoperative cross-sectional imaging can prevent unnecessary adrenalectomy in patients undergoing radical nephrectomy for renal cell carcinoma (RCC), according to findings presented at the American Urological Association 2012 annual meeting.

Stephen Blakely, MD, of the State University of New York Upstate Medical University in Syracuse, and colleagues studied 123 patients with documented ipsilateral adrenalectomy. Six patients (4.8%) had adrenal involvement and four of those patients had available imaging studies that demonstrated preoperative suspicion. In the 117 patients without adrenal involvement, 35 (30%) had available imaging studies, with five (14%) demonstrating suspicion for adrenal involvement. The average patient age was 60.6 years and average tumor size was 6.92 cm.

Preoperative imaging findings had a negative predictive value of 100% and a sensitivity and specificity of 100% and 95.9%, respectively. More than 95% of all adrenalectomies examined were performed unnecessarily.

“Ipsilateral adrenal involvement in RCC is uncommon and reliably predicted by preoperative cross-sectional imaging,” the researchers concluded.

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