Bancos I, Taylor AE, Chortis V, et al. - Researchers conducted this prospective multicentre study to validate a urine steroid metabolomics approach, using steroid profiling as the diagnostic basis for adrenocortical carcinoma (ACC). The sample consisted of adult participants (age ≥18 years) with newly diagnosed adrenal masses. Using a reference standard of histopathology and follow-up investigations, the accuracy of diagnostic imaging strategies was assessed based on maximum tumour diameter (≥ 4 cm vs < 4 cm), imaging characteristics (positive vs negative), and urine steroid metabolomics (low, medium, or high risk of ACC), separately and in combination. Of the 2,169 participants recruited between January 17, 2011, and July 15, 2016, the final analysis included 2017 from 14 specialist centres in 11 countries. Findings suggested that an unenhanced CT tumour attenuation cutoff of 20 HU should replace that of 10 HU for ACC exclusion. A triple test strategy of tumour diameter, imaging characteristics, and urine steroid metabolomics enhances the detection of ACC, which might shorten time to surgery for ACC patients and help prevent unnecessary surgery in patients with benign tumours.