{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T23:19:21Z","timestamp":1776122361689,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T00:00:00Z","timestamp":1485216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Incidentally discovered adrenal lesions known as adrenal incidentalomas (<jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content>) are being encountered with increasing frequency due to the widespread use of abdominal computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>). The aim of this study was to identify the clinical predictors of malignancy in <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> and to evaluate the accuracy of a recently proposed risk stratification algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of 96 patients presenting with <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> between 2004 and 2014 was undertaken; 66 patients underwent adrenalectomy, and 30 were managed non\u2010operatively. Univariate analysis including patient demographics, <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> features of tumour size, density and heterogeneity was performed. Hormonal parameters including 24\u2010h urinary\u2010free cortisol and serum dehydroepiandrosterone sulphate (<jats:styled-content style=\"fixed-case\">DHEAS<\/jats:styled-content>) were also included. A Cleveland Clinic risk stratification model utilizing adrenal size and density was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall rate of malignancy was 8%. On univariate analysis, the following preoperative variables were predictive of malignancy \u2013 tumour size on pathology (<jats:italic>P<\/jats:italic> = 0.0031) and <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> (<jats:italic>P<\/jats:italic> = 0.0016), heterogeneity on <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> imaging (<jats:italic>P<\/jats:italic> = 0.0036), a relative percentage washout of less than 40% (<jats:italic>P<\/jats:italic> = 0.0178), elevated 24\u2010h urinary\u2010free cortisol levels (<jats:italic>P<\/jats:italic> = 0.0176), elevated <jats:styled-content style=\"fixed-case\">DHEAs<\/jats:styled-content> (<jats:italic>P<\/jats:italic> = 0.0061) and younger age at presentation (<jats:italic>P<\/jats:italic> &lt; 0.0001). Evaluation of the Cleveland Clinic algorithm found an area under the <jats:styled-content style=\"fixed-case\">receiver operating characteristic<\/jats:styled-content> curve of 0.81 (95% <jats:styled-content style=\"fixed-case\">confidence interval<\/jats:styled-content> 0.52\u20131.00).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>\n<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> characteristics of tumour size, density and heterogeneity are significantly associated with malignancy in <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> and applied together reliably exclude malignancy. The risk stratification algorithm utilizing size and density alone may fail to identify some smaller adrenal cancers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.13868","type":"journal-article","created":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T22:54:08Z","timestamp":1485298448000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Predicting malignancy in adrenal incidentaloma and evaluation of a novel risk stratification algorithm"],"prefix":"10.1111","volume":"88","author":[{"given":"Elizabeth","family":"Foo","sequence":"first","affiliation":[{"name":"Endocrine Surgical Unit The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Turner","sequence":"additional","affiliation":[{"name":"School of Public Health The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan\u2010Chi","family":"Wang","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Aniss","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony J.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology Royal North Shore Hospital  Sydney New South Wales Australia"},{"name":"Cancer Diagnosis and Pathology Research Group Kolling Institute of Medical Research  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roderick","family":"Clifton\u2010Bligh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Royal North Shore Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Sywak","sequence":"additional","affiliation":[{"name":"Endocrine Surgical Unit The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,1,24]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"460","article-title":"Incidentally discovered adrenal masses","volume":"16","author":"Kloos RT","year":"1995","journal-title":"Endocr. 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