Objective: To investigate the clinical value of tumor size in the evaluation of endocrinological and histological natures regarding adrenal incidentaloma (AI) patients. Methods: A total of 1 941 AI patients who were hospitalized in Department of Endocrinology, Chinese PLA General Hospital between January 1997 and December 2016 were retrospectively reviewed. The demographics of patients, imaging features, functional status and histological results were analyzed. Results: Of 1 941 patients, 984 (50.70%) were males, and 957 (49.30%) were females. The median age was 52 years old. Endocrine evaluation according to the mass size showed that the proportion of non-functional AI and primary aldosteronism (PA) was declined from 84.55% (558/660) to 27.95% (45/161) and from 6.82% (45/660) to 0, respectively. The highest frequency of subclinical Cushing's syndrome (SCS), PA and pheochromocytomas were observed in 2.1-4.0, ≤2.0 and 4.0-6.0 cm group, respectively. Histological results showed that in>6 cm group, the frequency of malignancy were sharply increased. Multivariate logistical regression analysis indicated tumor size had a significant association with the presence of malignancy (OR=1.043, 95% CI: 1.033-1.054, P<0.001). A mass size of 4.0 cm was of great value in distinguishing malignant tumors from the benign ones, with a sensitivity of 89.19%, and a specificity of 69.91%. Conclusion: Mass size was of great value in the endocrinological evaluation, as well as distinguishing malignant tumors from the benign ones in AI patients.
目的： 探讨瘤体直径在肾上腺意外瘤(AI)性质评估中的价值。 方法： 回顾性研究。收集1997年1月至2016年12月在解放军总医院内分泌科住院诊治的AI患者的病例资料，包括患者的一般情况、影像学检查结果、术后病理结果、合并症等，依据瘤体最大径分为≤2.0、2.1～4.0、4.1～6.0以及>6.0 cm 4组，比较4组患者内分泌功能评估情况以及术后组织学病理特征。 结果： 本研究共纳入1 941例AI患者。男984例，女957例，男女比例为1.03∶1，就诊年龄中位数为52岁。对不同直径AI内分泌功能评估结果显示，无功能瘤和原发性醛固酮增多症随瘤体直径增大所占比例呈下降趋势，分别由84.55%(558/660)降至27.95%(45/161)，6.82%(45/660)降至0。亚临床库欣综合征在2.1～4.0 cm组中所占比例最高，为13.46%(89/661)。嗜铬细胞瘤在4.1～6.0 cm组和>6 cm组中所占比例较高(分别为45.81%和41.61%)。肾上腺皮质腺瘤随瘤体直径增大所占比例呈下降趋势，由83.02%(132/159)降至9.45%(12/127)。肾上腺皮质癌(ACC)及其他恶性肿瘤(转移癌、淋巴瘤等)随直径增加所占比例明显上升，分别由0上升至9.45%(12/127)，0.63%(1/159)上升至10.24%(13/127)。校正性别、年龄后，随瘤体直径增大，恶性肿瘤发生风险也增加(OR＝1.043，95% CI：1.033～1.054，P<0.001)。瘤体直径切点为4 cm时诊断恶性肿瘤的Youden指数最大，灵敏度为89.19%，特异度为69.91%。 结论： 无论是对内分泌功能评估还是良恶性鉴别，瘤体直径大小均具有重要的参考价值。.
Keywords: Adrenal incidentaloma; Adrenocortical carcinoma; Hyperaldosteronism; Non-functional adrenal adenoma; Pheochromocytoma; Subclinical Cushing′s syndrome.