Your browser doesn't support javascript.
loading
Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study.
Bancos, Irina; Taylor, Angela E; Chortis, Vasileios; Sitch, Alice J; Jenkinson, Carl; Davidge-Pitts, Caroline J; Lang, Katharina; Tsagarakis, Stylianos; Macech, Magdalena; Riester, Anna; Deutschbein, Timo; Pupovac, Ivana D; Kienitz, Tina; Prete, Alessandro; Papathomas, Thomas G; Gilligan, Lorna C; Bancos, Cristian; Reimondo, Giuseppe; Haissaguerre, Magalie; Marina, Ljiljana; Grytaas, Marianne A; Sajwani, Ahmed; Langton, Katharina; Ivison, Hannah E; Shackleton, Cedric H L; Erickson, Dana; Asia, Miriam; Palimeri, Sotiria; Kondracka, Agnieszka; Spyroglou, Ariadni; Ronchi, Cristina L; Simunov, Bojana; Delivanis, Danae A; Sutcliffe, Robert P; Tsirou, Ioanna; Bednarczuk, Tomasz; Reincke, Martin; Burger-Stritt, Stephanie; Feelders, Richard A; Canu, Letizia; Haak, Harm R; Eisenhofer, Graeme; Dennedy, M Conall; Ueland, Grethe A; Ivovic, Miomira; Tabarin, Antoine; Terzolo, Massimo; Quinkler, Marcus; Kastelan, Darko; Fassnacht, Martin.
Afiliação
  • Bancos I; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
  • Taylor AE; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
  • Chortis V; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingh
  • Sitch AJ; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
  • Jenkinson C; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
  • Davidge-Pitts CJ; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
  • Lang K; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingh
  • Tsagarakis S; Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
  • Macech M; Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
  • Riester A; Medizinische Klinik and Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Deutschbein T; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.
  • Pupovac ID; Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Kienitz T; Endocrinology in Charlottenburg, Berlin, Germany.
  • Prete A; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingh
  • Papathomas TG; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
  • Gilligan LC; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
  • Bancos C; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
  • Reimondo G; Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy.
  • Haissaguerre M; Department of Endocrinology, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France.
  • Marina L; Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Grytaas MA; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
  • Sajwani A; School of Medicine, National University of Ireland Galway, Galway, Ireland.
  • Langton K; Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
  • Ivison HE; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
  • Shackleton CHL; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; UCSF Benioff Children's Hospital Oakland Research Institute, Oakland, CA, USA.
  • Erickson D; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
  • Asia M; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • Palimeri S; Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
  • Kondracka A; Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
  • Spyroglou A; Medizinische Klinik and Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Ronchi CL; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingh
  • Simunov B; Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Delivanis DA; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
  • Sutcliffe RP; Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • Tsirou I; Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
  • Bednarczuk T; Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
  • Reincke M; Medizinische Klinik and Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany.
  • Burger-Stritt S; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany.
  • Feelders RA; Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands.
  • Canu L; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
  • Haak HR; Department of Internal Medicine, Maxima Medisch Centrum, Eindhoven, Netherlands; Department of Health Services Research and CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
  • Eisenhofer G; Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany.
  • Dennedy MC; School of Medicine, National University of Ireland Galway, Galway, Ireland.
  • Ueland GA; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
  • Ivovic M; Department for Obesity, Reproductive and Metabolic Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Tabarin A; Department of Endocrinology, Hôpital Haut Lévêque, CHU de Bordeaux, Pessac, France.
  • Terzolo M; Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy.
  • Quinkler M; Endocrinology in Charlottenburg, Berlin, Germany.
  • Kastelan D; Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Fassnacht M; Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Würzburg, University of Würzburg, Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, University of Würzburg, Würzburg, Germany; Central Laboratory, University Hospita
Lancet Diabetes Endocrinol ; 8(9): 773-781, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32711725
ABSTRACT

BACKGROUND:

Cross-sectional imaging regularly results in incidental discovery of adrenal tumours, requiring exclusion of adrenocortical carcinoma (ACC). However, differentiation is hampered by poor specificity of imaging characteristics. We aimed to validate a urine steroid metabolomics approach, using steroid profiling as the diagnostic basis for ACC.

METHODS:

We did a prospective multicentre study in adult participants (age ≥18 years) with newly diagnosed adrenal masses. We assessed the accuracy of diagnostic imaging strategies based on maximum tumour diameter (≥4 cm vs <4 cm), imaging characteristics (positive vs negative), and urine steroid metabolomics (low, medium, or high risk of ACC), separately and in combination, using a reference standard of histopathology and follow-up investigations. With respect to imaging characteristics, we also assessed the diagnostic utility of increasing the unenhanced CT tumour attenuation threshold from the recommended 10 Hounsfield units (HU) to 20 HU.

FINDINGS:

Of 2169 participants recruited between Jan 17, 2011, and July 15, 2016, we included 2017 from 14 specialist centres in 11 countries in the final analysis. 98 (4·9%) had histopathologically or clinically and biochemically confirmed ACC. Tumours with diameters of 4 cm or larger were identified in 488 participants (24·2%), including 96 of the 98 with ACC (positive predictive value [PPV] 19·7%, 95% CI 16·2-23·5). For imaging characteristics, increasing the unenhanced CT tumour attenuation threshold to 20 HU from the recommended 10 HU increased specificity for ACC (80·0% [95% CI 77·9-82·0] vs 64·0% [61·4-66.4]) while maintaining sensitivity (99·0% [94·4-100·0] vs 100·0% [96·3-100·0]; PPV 19·7%, 16·3-23·5). A urine steroid metabolomics result indicating high risk of ACC had a PPV of 34·6% (95% CI 28·6-41·0). When the three tests were combined, in the order of tumour diameter, positive imaging characteristics, and urine steroid metabolomics, 106 (5·3%) participants had the result maximum tumour diameter of 4 cm or larger, positive imaging characteristics (with the 20 HU cutoff), and urine steroid metabolomics indicating high risk of ACC, for which the PPV was 76·4% (95% CI 67·2-84·1). 70 (3·5%) were classified as being at moderate risk of ACC and 1841 (91·3%) at low risk (negative predictive value 99·7%, 99·4-100·0).

INTERPRETATION:

An unenhanced CT tumour attenuation cutoff of 20 HU should replace that of 10 HU for exclusion of ACC. A triple test strategy of tumour diameter, imaging characteristics, and urine steroid metabolomics improves detection of ACC, which could shorten time to surgery for patients with ACC and help to avoid unnecessary surgery in patients with benign tumours.

FUNDING:

European Commission, UK Medical Research Council, Wellcome Trust, and UK National Institute for Health Research, US National Institutes of Health, the Claire Khan Trust Fund at University Hospitals Birmingham Charities, and the Mayo Clinic Foundation for Medical Education and Research.
Assuntos

Similares

MEDLINE

...
LILACS

LIS

Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Esteroides / Neoplasias das Glândulas Suprarrenais / Metabolômica Tipo de estudo: Ensaio clínico controlado / Estudo diagnóstico / Estudo observacional / Estudo prognóstico / Fatores de risco Limite: Adulto / Idoso / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: Europa Idioma: Inglês Revista: Lancet Diabetes Endocrinol Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Estados Unidos