#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 thelancet.com/journals/landi… 
#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 eje.bioscientifica.com/view/journals/…
#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 academic.oup.com/jcem/article/9…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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%) thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#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 thelancet.com/journals/landi…
#13 Read the @LancetEndo comment doi.org/10.1016/S2213-… which accompanies the publication of the #ENSAT #EURINEACT study thelancet.com/journals/landi… and charts the expected impact of its findings on patients with adrenal tumours
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The #EURINEACT study has been made possible by generous funders incl. the Claire Khan Trust @QEHBCharity created to help speed up diagnosis and improve treatment of #ACC - Claire Khan died 25 years ago at the age of 18 - read about her here ensat.org/page-1317328 @ACCSupportUK
