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<p>Adrenocortical carcinoma is a rare and clinically heterogeneous malignancy, often posing difficulty in accurate prognostication. Existing clinicopathological scoring systems, the Weiss, AFIP/Wieneke, and Lin-Weiss-Bisceglia (LWB) criteria, are constrained by their age/subtype-specific applicability and are not suitable for evaluating the rare myxoid and sarcomatoid morphologies or needle biopsies. The Reticulin Algorithm (RA) is a simplified approach for the histopathological assessment of adrenocortical neoplasms, but its prognostic utility requires further validation. We evaluated the prognostic performance of RA and its pediatric-adaptation (pRA) in 157 adrenocortical neoplasms, comprising 140 resection specimens and 17 needle biopsies from 118 adult and 39 pediatric patients, representing all histomorphological subtypes. Among adult tumors, the RA demonstrated diagnostic accuracy exceeding 90%, comparable to the Weiss system but with higher specificity and a markedly superior positive likelihood ratio, highlighting its stronger prognostic value. Its greatest impact was observed in oncocytic tumors, where it outperformed the LWB criteria and correctly reclassified most lesions previously designated as having uncertain malignant potential. In pediatric cases, RA’s performance was comparable to the AFIP/Wieneke criteria. Notably, pRA further improved predictive precision. All myxoid and sarcomatoid tumors were appropriately classified using the algorithm. RA application to needle biopsies showed complete concordance with clinical outcomes. Survival analyses confirmed significant stratification between RA-defined benign and malignant groups. In this large single-center study, RA demonstrated broad applicability and prognostic utility across age groups, histologic subtypes, and specimen types, supporting its potential role in risk stratification of adrenocortical neoplasms.</p>

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Validation of the Reticulin Algorithm for Adrenocortical Neoplasms: Assessing Diagnostic Accuracy Across All Age Groups and Histological Subtypes

  • 期刊论文

  • 发表日期：

    2026年2月21日

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  • Hemlata Jangir,
  • Sanjay Sriram,
  • Sonali Dixit,
  • Shipra Agarwal,
  • Sameer Rastogi,
  • Jagdish Prasad Meena,
  • Yashdeep Gupta,
  • Rajni Sharma,
  • Rajeev Kumar,
  • Om Prakash,
  • Vishesh Jain,
  • Sandeep Agarwala,
  • Mehar Chand Sharma,
  • Venkateswaran K. Iyer

摘要

Adrenocortical carcinoma is a rare and clinically heterogeneous malignancy, often posing difficulty in accurate prognostication. Existing clinicopathological scoring systems, the Weiss, AFIP/Wieneke, and Lin-Weiss-Bisceglia (LWB) criteria, are constrained by their age/subtype-specific applicability and are not suitable for evaluating the rare myxoid and sarcomatoid morphologies or needle biopsies. The Reticulin Algorithm (RA) is a simplified approach for the histopathological assessment of adrenocortical neoplasms, but its prognostic utility requires further validation. We evaluated the prognostic performance of RA and its pediatric-adaptation (pRA) in 157 adrenocortical neoplasms, comprising 140 resection specimens and 17 needle biopsies from 118 adult and 39 pediatric patients, representing all histomorphological subtypes. Among adult tumors, the RA demonstrated diagnostic accuracy exceeding 90%, comparable to the Weiss system but with higher specificity and a markedly superior positive likelihood ratio, highlighting its stronger prognostic value. Its greatest impact was observed in oncocytic tumors, where it outperformed the LWB criteria and correctly reclassified most lesions previously designated as having uncertain malignant potential. In pediatric cases, RA’s performance was comparable to the AFIP/Wieneke criteria. Notably, pRA further improved predictive precision. All myxoid and sarcomatoid tumors were appropriately classified using the algorithm. RA application to needle biopsies showed complete concordance with clinical outcomes. Survival analyses confirmed significant stratification between RA-defined benign and malignant groups. In this large single-center study, RA demonstrated broad applicability and prognostic utility across age groups, histologic subtypes, and specimen types, supporting its potential role in risk stratification of adrenocortical neoplasms.