Potential for NLS-Scopy In Adrenal Tumor Diagnosis

B.I. Lukashenko,

T.B. Georgadze

Adrenal tumors do not occur very often: still they are known to be the most

hormoneactive and even if small sized cause various glandular disorders. However in

practice adrenal tumors often clinically develop with no symptoms in evidence or are

accompanied by vague complaints.

Both documentary evidence and our experience show that 6 months to two years may

elapse from primary disease manifestations to forming a diagnosis. Early detection of

adrenal tumors has become an important clinical problem, which is now conventionally

solved by means of ultrasound investigations (US) along with computer tomography (CT),

magnetic resonance tomography (MRT) and angiography (AG).

Today NLS-scopy is one of the most advanced informative hardware-based methods of

diagnosis. The NLS method will allow a substantially increase in the early and accurate

diagnosis of adrenal tumors. The implementation of the latest devices equipped with

digital trigger sensors made it possible to detect any growth sized around 1 cm in

adrenals, which is comparable to computer tomography in terms of diagnostic accuracy.

This our research aimed to study the NLS-scopy potentials in adrenal tumor diagnosis

and to provide an evidence that with a proper procedural approach and advanced

equipment in place, bulky growths could be diagnosed as successfully as if by using

computer-aided and magnetic resonance tomography.

Subject and methods

Clinical data: from June 2000 through May 2001 23 patients aged 25-64 were examined

who were suspected to have developed adrenal tumors based on careful complaint

analysis and clinical and lab data. For all the patients kidney and adrenal investigation

was conducted under a regular procedure using a 4.9 GHz NLS unit. The device has an

automatic focusing, that can self adjust both when emitting and receiving echo signals,

and it ensures high definition of the spectrogram, which is very important, for example, for

differential diagnosis. As a result of using high frequency sensors in combination

with virtual imaging equipment, a high spatial resolution is provided which is very

important for patient examination.

According to the analysis of our observations, the correct diagnosis was made for 22

patients of 23 (95.6%). In one female patient with Itzenko-Kusching syndrome in clinical

evidence the NLS-scopy detected in the superior pole area of the right kidney a small (30-

35 mm) hyperchromous growth which had a mono-chromous internal structure and a

spectral similarity to the ‘adrenal adenoma’ reference standard (d=0.217) and was

regarded as a benign adrenal tumor. Because of typical clinical presentation of Itzenko-

Kusching syndrome and concomitant changes in blood and urine in clinical and lab

43evidence, computer tomography was not performed. The surgery detected a focal

macronodal hyperplasia of the adrenal, which was confirmed by the histological

investigation of the removed growth.

Generally a distinction is made between the diffuse and focal hyperplasia. Focal

hyperplasia can be subdivided into micro- and macro-nodal hyperplasia. As a matter of

fact, focal hyperplasia can not be easily discriminated from adrenal tumors by means of

NLS evidence, so in this particular case our conclusions cannot be considered to be

diagnostically wrong.

Of 23 cases computer tomography was undertaken for 17 with its data matching the

NLSinvestigation results. 9 patients of 23 underwent surgery to have an adrenal tumor

removed, and the NLS data were confirmed by surgery and histological investigation

results.

The size of detected tumors varied in diameter from 6 to 10 cm. All of them had a

capsule, smooth surface and rounded or oval shape. Small tumors had a monochrome

structure and in 4 cases with the tumor size over 8 cm, the internal structure was

represented by an irregular alternation of areas having different color saturation on

account of necrotic zones, degenerative changes and decalcification, which was

confirmed by a histological investigation of the removed tumors.

According to the literature and our information the different diagnosis of benign and

malignant adrenal tumors is an extremely difficult process. A malignant pattern of the

detected growth can be suspected only in the presence of an irregular internal structure of

the growth, restricted kidney mobility at forced breathing, enlarged regional lymph nodes

and metastases in other organs.

Thus, diagnosis of adrenal tumors is complicated because of diverse clinical implications

in place. The potentials of the NLS-diagnosis could scarcely be overestimated, for the

simplicity of the investigation procedure, its harmlessness and rich informational content

allowed us to make a correct and prompt diagnosis in 78% of cases. The investigation

showed that NLS-scopy may become as efficient method of adrenal tumor examination

as computer tomography and US. Patients having complaints typical for adrenal tumors

should be examined by means of the NLS-method the first. Patients with symptoms

indicative of adrenal tumor should be referred to specialized endocrine surgery

departments where they would be thoroughly investigated using US, CT and MRT which will

enable a substantial reduction in the investigation time and thus a more appropriate and

early treatment.