Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 RPE-01 RPE-02 Diagnostic Dilemmas: A Multi-Institutional Retrospective Analysis of Adrenal Incidentaloma Pathology Based on Radiologic Size D. Zekan 1 , R. King 2 , A. Hajiran 1,3 , A. Patel 4 , S. Deem 2 , A. Luchey 1 1 West Virginia University Department of Urology, Morgantown, WV, USA; 2 Charleston Area Medical Center Department of Urology, Charleston, WV, USA; 3 Moffitt Cancer Center Department of Urology, Tampa, FL, USA; 4 Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA Introduction and Objective: Adrenal incidentalomas (AIs) are masses >1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses. Methods: 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, <18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression. Results: 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured >6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p = 0.008 and 0.011). Conclusions: Our results question the generally-accepted 4 cm cutoff for excision ofmetabolically-silentAIs. They suggest a 6 cmthresholdwould suffice to avoid removal of benign lesions while maintaining sensitivity for ACC. Risk of Secondary Malignancies After Pelvic Radiation: A Population- Based Analysis A. Salib, C. McPartland, J. Mark, E. Trabulsi, C. Lallas, L. Gomella, T. Chandrasekar Thomas Jefferson University Hospital, Philadelphia, PA, USA Introduction andObjective: Radiation therapy (RT) is an integral component of the multimodal therapy of pelvic malignancies, either as primary treatment or in combinationwith surgical resection. In addition to local treatment effects on nearby pelvic organs, RT has been established to be a risk factor for delayed secondary malignancies. In this study, we examine the rate of secondary malignancies following RT for primary pelvic malignancies. Methods: Using the SEER (Surveillance, Epidemiology, and Ends Results) database, we retrospectively examined 2,102,192 patients with primary pelvic malignancies (prostate, bladder, uterine, rectal, cervical). For each disease site, we compared the rate of all secondary malignancies in radiated patients to non- radiated patients. Secondary malignancies were then stratified as pelvic and non-pelvic, in order to determine the effect of RT. Results: A total of 2,102,192 patients were examined with a total of 113,322 patients developed secondarymalignancies after RT (Table 1). After RT, 26,299 patients developed secondary pelvic malignancies (18,411 prostate, 1,026 bladder, 1,410 cervical, 2,179 uterine, 3,273 rectal) (Table 2). The overall relative risk (RR) of RT on developing a secondary malignancy was 1.79 (1.77-1.80 CI, P<0.0001), particularly in patients with prostate (RR 2.57), uterine (RR 1.24) and cervical cancer (1.09). The overall RR of RT on developing a secondary pelvic malignancy was 2.09 (2.06-2.13 CI, P<0.0001), particularly in patients with bladder (RR 6.90), prostate (RR 2.74), and uterine cancer (RR 1.21). Conclusions: Radiation treatment for pelvic malignancies increases the risk of developing secondary malignancies over the patient’s lifetime. Further work is needed to identify at risk populations. Resident Prize Essay Podium Session 2