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The differential diagnosis of adrenocortical tumors: systematic review of Ki-67 and IGF2 and meta-analysis of Ki-67

2025-04-01Research article Open access
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datacite.subject.sdg03:Saúde de Qualidade
dc.contributor.authorOliveira, Sofia B.
dc.contributor.authorMachado, Mariana Q.
dc.contributor.authorSousa, Diana
dc.contributor.authorPereira, Sofia S.
dc.contributor.authorPignatelli, Duarte
dc.date.accessioned2025-08-05T10:58:51Z
dc.date.available2025-08-05T10:58:51Z
dc.date.issued2025-04-01
dc.description.abstractDistinguishing benign from malignant adrenocortical tumors (ACT) is not always easy, particularly for tumors with unclear malignant potential based on the histopathological features comprised of the Weiss score. Previous studies reported the potential utility of immunohistochemistry (IHC) markers to recognize malignancy, in particular the Insulin-like growth factor 2 (IGF2) and the proliferation marker, Ki-67. However, this information was not compiled before. Therefore, this review aimed to collect the evidence on the potential diagnosis utility of IGF2 and Ki-67 IHC staining. Additionally, a meta-analysis was performed to assess the Ki-67 accuracy to identify adrenocortical carcinoma. The systematic review and meta-analysis were conducted according to the PRISMA guidelines. From the 26 articles included in the systematic review, 21 articles provided individual data for IGF2 (n = 2) or for Ki-67 (n = 19), while 5 studies assessed both markers. IGF2 staining was positive in most carcinomas, in contrast to adenomas. However, the different immunostaining evaluation methods adopted among the studies impeded to perform a meta-analysis to assess IGF2 diagnostic accuracy. In contrast, for the most commonly used cut-off value of 5% stained cells, Ki-67 showed pooled specificity, sensitivity and log diagnostic odds ratio of 0.98 (95% CI 0.95 to 0.99), 0.82 (95% CI 0.65 to 0.92) and 4.26 (95% CI 3.40 to 5.12), respectively. At the 5% cut-off, Ki-67 demonstrated an excellent specificity to recognize malignant ACT. However. the moderate sensitivity observed indicates the need for further studies exploring alternative threshold values. Additionally, more studies using similar approaches are needed to assess the diagnostic accuracy of IGF2. Registration code in PROSPERO: CRD42022370389.eng
dc.identifier.doi10.1007/s11154-025-09945-w
dc.identifier.eid85217163637
dc.identifier.issn1389-9155
dc.identifier.other2f36afc2-f4b1-4423-accd-8279cea2260e
dc.identifier.pmcPMC11920293
dc.identifier.pmid39890749
dc.identifier.urihttp://hdl.handle.net/10400.14/54148
dc.identifier.wos001448998500002
dc.language.isoeng
dc.peerreviewedyes
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAdrenocortical tumors
dc.subjectDiagnosis
dc.subjectIGF2
dc.subjectImmunohistochemistry
dc.subjectKi-67
dc.subjectMeta-analysis
dc.titleThe differential diagnosis of adrenocortical tumors: systematic review of Ki-67 and IGF2 and meta-analysis of Ki-67eng
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.endPage278
oaire.citation.issue2
oaire.citation.startPage261
oaire.citation.titleReviews in Endocrine and Metabolic Disorders
oaire.citation.volume26
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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