#1 New @IMSR_UoB @UoB_IAHR research: Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas: a prospective test validation study – learn all about the #EURINEACT study in this twitter thread and read its results #OpenAccess http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#2 Cross-sectional imaging by CT or MRI regularly discovers adrenal masses; 2-12% are eventually diagnosed as adrenal cortical carcinoma #ACC . However, limited specificity of imaging prevents accurate detection of #ACC https://eje.bioscientifica.com/view/journals/eje/175/2/R51.xml

#3 Urine Steroid Metabolomics combines steroid profiling by mass spectrometry with data analysis by a machine learning algorithm. This non-invasive, radiation-free biomarker tool can detect a malignant “steroid fingerprint” in the urine of #ACC patients https://academic.oup.com/jcem/article/96/12/3775/2834942

#4 #EURINEACT prospectively compared the accuracy of urine steroid metabolomics and imaging in detecting #ACC in patients with newly diagnosed adrenal masses– the largest ever (N=2017) adrenal tumour study, achieved by #ENSAT http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#5 In #EURINEACT, 1529 (76%) of the 2017 prospectively recruited patients had a tumour diameter <4cm; only 2 of those (0.1%) had #ACC. A 4cm cut-off had high sensitivity but limited specificity for #ACC http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#6 #EURINEACT shows that a 20HU unenhanced CT tumour attenuation cutoff provides similar sensitivity to the currently used 10HU cut-off in detecting #ACC (99% vs. 100%) but superior specificity (80% vs. 64%), decreasing the risk of wrongly diagnosing #ACC http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#7 Urine Steroid Metabolomics had a higher positive predictive value (34.6%) for #ACC than tumour size (>4cm; 19.7%) and Imaging Characteristics (unenh. CT >20HU; 19.7%). A triple test with all three parameters provided best accuracy (PPV 76.4%; NPV 99.7%) http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#8 Applying urine steroid metabolomics to adrenal masses >4cm and with unenhanced CT attenuation >20HU is likely to improve detection and time to surgery in #ACC and help avoid unnecessary scans and surgeries in benign masses http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#9 #EURINEACT is a Pan-European interdisciplinary collaboration of clinical endocrinologists, steroid biochemists, mass spectrometrists, diagnostic test specialists and computer scientists – we thank the #EURINEACT investigators and the #ENSAT network http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#10 #EURINEACT took 10 years from conception to publication. We are grateful to our funders @EU_Commission #ENSATCANCER @The_MRC @wellcometrust @NIDDKgov @NIHRBhamBRC @UHBCharities Claire Khan Trust and the @unibirmingham @MayoClinic Exchange Fund http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#11 During the #EURINEACT study, the joint first authors @IrinaBancos and @Angela_E_Taylor gave birth to three children, raised their young families and progressed their careers, in equal partnership with great husbands #WomeninSTEM #WomeninScience http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#12 This thread is dedicated to the memory of an #ENSAT founding father, Bruno Allolio, a great clinician scientist, mentor and friend - he would have loved to see the #EURINEACT results and their impact on patients with #ACC and adrenal tumours http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext

#13 Read the @LancetEndo comment https://doi.org/10.1016/S2213-8587(20)30224-2 which accompanies the publication of the #ENSAT #EURINEACT study http://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30218-7/fulltext and charts the expected impact of its findings on patients with adrenal tumours

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