What is the role of ultrasonography in the follow-up of adrenal incidentalomas?

Objectives. The incidental discovery of an adrenal mass has become a freque nt finding because of the increased use and technical improvement of comput ed tomography (CT) and magnetic resonance imaging. The approach to the inve stigation of these masses is ill-defined, and unequivocal guidelines for th eir management are lacking. The first problem concerns the distinction betw een malignant masses requiring surgery and the more frequent benign masses. In the case of a benign mass, an additional problem is the method of follo w-up, considering cost, discomfort to the patient, and the consequences of false-positive results. The aim of this study was to evaluate the possible role of ultrasonography (US) in the follow-up of incidentally discovered ad renal masses. Methods. Two hundred eight cases of adrenal incidentalomas consecutively di agnosed in Piedmont, Italy from 1989 to 1996 and collected for a retrospect ive multicenter analysis were used. The US and CT characteristics of the ad renal masses were compared in patients who underwent surgery, Results. Most patients were 50 to 69 years of age; women were predominantly affected. CT was more reliable than US in detecting the malignant nature o f an adrenal lesion. The mass diameter measured by US and CT was clearly co rrelated. Conclusions. At diagnosis, US was not sufficiently reliable in evaluating a drenal mass characteristics. Considering the high correlation between US an d CT size estimation, in the case of a presumably benign lesion, US could b e considered a simple, economic, and effective method of follow-up, with CT limited to evaluating masses growing over time (CT remains mandatory at di agnosis). UROLOGY 54: 612-616, 1999. (C) 1999, Elsevier Science Inc.