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국문

암환자에서 발견된 부신결절에 대해 전이암 여부를 판단하는 것이 환자치료방침 결정을 위해매우 중요함. 미국영상의학회의 권고안에 따르면 모든 암환자에서 발견된 부신결절에 대해 우선적으로 비조영 CT에서 양성 종양 여부를 판단하게 됨. 비조영 CT영상이 없거나 영상소견으로 양성 여부를 판정할 수 없을 때, 부신 CT 를 시행. 유럽 내분비학회를 비롯한 여러 학회의 진료지침에서도 부신 CT, MRI, PET/CT 등 추가적인 영상검사를 권고.
이렇듯 많은 진료 지침에서 부신 결절에 대해 추가 영상검사를 시행할 것을 권고하고 있으나 권고에 대한 증거 수준은 매우 낮음. 암 환자에서의 부신 혹에 대한 이전 연구에서는 각 암종 및 암종의 병기에 대한 고려가 없으며 수술을 시행한 환자들만을 포함하여 연구에 심한 selection bias가 있음.
또한, 위암이 있는 환자에서 부신 결절이 발견된 경우, 다른 폐암이나 유방암에 비해 전이의 유병률이 낮다고 알려져 있고, 특히나 다른 장기의 전이가 없이 부신 전이 단독으로 발현하는 위암의 가능성은 경험상 매우 낮을 것으로 생각됨. 하지만 전이 없는, 절제 가능한 위암 환자군에서 발견된 부신 결절 중 악성 결절이 차지하는 유병률에 대한 연구는 없음. 이에 절제 가능한 위암 환자 군에서 악성 부신 결절의 유병률을 파악하고자 함

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An adrenal nodule is detected not infrequently during staging work up for malignancies. If an adrenal nodule is discovered without evidence of metastasis elsewhere, determining the nature of the nodule becomes critical for the patient management. However, there is no specific guideline on how an adrenal nodule detected during staging work up for gastric cancer should be managed. The ACR (American College of Radiology) guideline recommends adrenal CT for all incidentally detected adrenal nodules in patients with history of malignancy without metastasis elsewhere, unless there are imaging features typical of a benign lesion, or prior imaging that proves the stability of the nodule. Even after adrenal CT is performed, PET-CT or biopsy may be additionally required in case the nodule does not display features typical of benign adrenocortical adenoma. 
In previous investigations on adrenal nodules detected in patients with malignancy, up to 70% of these nodules were malignant. However, there was serious selection bias in these studies, as they included only pathologically confirmed nodules. All these nodules would probably have lacked imaging finding suggestive of benignity, thus requiring biopsy or surgical resection. Moreover, these studies included patients with cancers of various origins, including lung or breast cancers that are known to have higher prevalence of adrenal metastasis compared to gastric cancer. 
The exact incidence of solitary manifestation of an adrenal metastasis in gastric cancer is not known but is expected to be extremely low. Adhering to the ACR guideline in gastric cancer patients may incur unnecessary costs and anxiety of patients without substantial diagnostic yield. 
Thus, in this study, we aimed to measure the prevalence of malignant adrenal nodule detected in staging CTs of gastric cancer patients with potentially resectable gastric cancer without distant metastasis.

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Patients diagnosed as having gastric cancer via endoscopic biopsy or resection, and those suspected as having gastric cancer even though their endoscopy biopsy results, from 2003 to 2018

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Patients who underwent esophagogastroduodenoscopy in Seoul National University Bundang hospital (SNUBH), from 2003 to 2018. No restriction regarding patient age or sex was made. Patients diagnosed as having gastric cancer via endoscopic biopsy or resection, and those suspected as having gastric cancer although their biopsy results. Among these patients, those with potentially resectable gastric cancer without distant metastasis at the time of staging CT will be included.

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Non-probability sampling was used. Pathology database is searched to identify patients with gastric cancer diagnosed via endoscopic biopsy or endoscopic mucosal resection/endoscopic submucosal dissection. Additionally, patients with suspected cancer will be included, even though their endoscopy results were negative. To include these patients, endoscopy reports from 2003 to 2018 will be retrospectively reviewed. Reports containing the words "advanced gastric cancer, early gastric cancer, tumor, neoplasm, cancer, malignancy" will be identified, and those reports will be manually reviewed to identify patients who were suspected as having gastric cancer although their biopsy results were negative. 
Then, among those patients with endoscopically diagnosed or suspected gastric cancer, we will select and include the patients with potentially resectable gastric cancer without metastasis at the time of staging CT by reviewing their medical records .

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stomach, carcinoma, stomach neoplasms, adrenal glands

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Prevalence of adrenal nodule (the proportion of patients with any adrenal nodule among all patients)

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After retrospective image review

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Proportion of malignant adrenal nodule (the proportion of patients with malignant adrenal nodule among all patients with adrenal nodules

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After retrospective image review

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Proportion of adrenal metastasis from gastric cancer (the proportion of patients with adrenal metastasis from gastric cancer among patients with adrenal nodules)

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After retrospective image review

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Proportion of patients who underwent additional adrenal examination among patients with adrenal nodule

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After retrospective image review

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