Preoperative evaluation of adrenal lesions based on imaging studies and laparoscopic adrenalectomy in patients with otherwise operable lung cancer

Summary 

Purpose

An unsuspected adrenal mass (AM) could be discovered in patients with operable non-small-cell lung carcinoma (NSCLC), but it is difficult to determine the nature of AM. The purpose of the study is to answer the question as to which decision should be made when assessing AM in patients with NSCLC.

Patients and methods

From 1997 to 2005, 40 patients (31 male; mean age: 63 years) were identified to have both NSCLC and AM. We tried to determine the nature of AM based on imaging studies with or without laparoscopic adrenalectomy. When AM was considered benign on CT or PET-CT, surgical resection of NSCLC was performed (group 1, n=25). When AM was considered indeterminate on CT or PET-CT, we performed MRI to determine the operability. In eight patients, surgical resection of NSCLC was performed, because AM was considered benign on MRI (group 2). In seven patients, adrenalectomy was performed to confirm AM pathologically, because all imaging studies were indeterminate (group 3).

Results

Follow-up was complete for all patients with a mean duration of 33.1 months (3–104.5). In group 1, no patients showed adrenal metastases, except one who died of adrenal metastasis. In group 2, three patients revealed that they had had adrenal metastases when staging and two died of adrenal metastasis. In group 3, one patient had an adrenal metastasis and the others had benign lesions.

Conclusions

We suggest that when AM is considered benign on CT or PET-CT, surgical resection of NSCLC is indicated. However, when AM is indeterminate on CT or PET-CT, histopathologic confirmation is needed to determine the nature of AM.

Keywords: Adrenal, Non-small-cell lung carcinoma, CT, PET, MRI, Adrenalectomy