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Tikkakoski T, Taavitsainen M, Päivänsalo M, Lähde S, Apaja-Sarkkinen M. Accuracy of Adrenal Biopsy Guided by Ultrasound and CT. Acta Radiol 2016. [DOI: 10.1177/028418519103200507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We reviewed the results of fine needle biopsy of the adrenal glands guided by ultrasonography or CT in 56 patients. The final diagnoses, obtained at operation, autopsy or follow-up were: metastasis (n = 22), adenoma (n = 21), adrenal cyst (n = 6), hematoma (n = 3), lymphoma (n = 1), pheochromocytoma (n= 1), lymph node (n = 1), and amyloid mass (n= 1). Sufficient cytologic material was obtained in 96.4% (54/56). The overall accuracy to differentiate benign from malignant disease was 85.7% (48/56), 2 were false-negative, one was false-positive. The biopsy was inconclusive (“possibly malignant”) in 3 patients, 2 of whom had an additional cutting needle biopsy yielding a correct positive finding. No complications occurred. We conclude that in disseminated malignant disease with suspected adrenal metastases diagnostic results can be obtained with guided fine needle biopsy. Biopsy in primary adrenal lesions is helpful, especially if the aspirate of the lesion turns out to be composed of something other than adrenal cells.
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Williams AR, Hammer GD, Else T. Transcutaneous biopsy of adrenocortical carcinoma is rarely helpful in diagnosis, potentially harmful, but does not affect patient outcome. Eur J Endocrinol 2014; 170:829-35. [PMID: 24836548 PMCID: PMC4096775 DOI: 10.1530/eje-13-1033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The utility, sensitivity, and effect on patient outcome of transcutaneous adrenal biopsy (TAB) for single, large, adrenal masses are unclear. OBJECTIVE This study evaluated the utility, diagnostic sensitivity, and effect on patient outcome of TAB in patients with ACC. DESIGN AND SETTING We conducted a retrospective review of the electronic medical records of all ACC patients who were evaluated at the University of Michigan Health System from 1991 to 2011. We evaluated the sensitivity of TAB for tumors with the final pathological diagnosis of ACC. We compared the characteristics and survival of patients with stage I-III disease who underwent TAB with those who did not undergo TAB. RESULTS A total of 75 ACC patients with TAB were identified. Complications occurred in at least 11% of patients and were mainly associated with bleeding. The maximum sensitivity of the procedure in diagnosing ACC was 70%. For stage I-III patients, baseline characteristics, stage at diagnosis, and adjuvant treatment with mitotane or radiation were not significantly different between the TAB (n=36) and the non-TAB (n=254) groups. There was no significant difference in recurrence-free (P=0.7) or overall survival (P=0.7) between patients who underwent TAB and those who did not. CONCLUSIONS TAB of single, large, adrenal masses is usually unnecessary, exposes patients to risk, but does not affect recurrence-free or overall survival.
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Affiliation(s)
- Andrew R Williams
- University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA
| | - Gary D Hammer
- University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA
| | - Tobias Else
- University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA
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Vanderveen KA, Thompson SM, Callstrom MR, Young WF, Grant CS, Farley DR, Richards ML, Thompson GB. Biopsy of pheochromocytomas and paragangliomas: Potential for disaster. Surgery 2009; 146:1158-66. [DOI: 10.1016/j.surg.2009.09.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
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Jhala NC, Jhala D, Eloubeidi MA, Chhieng DC, Crowe DR, Roberson J, Eltoum I. Endoscopic ultrasound-guided fine-needle aspiration biopsy of the adrenal glands: analysis of 24 patients. Cancer 2004; 102:308-14. [PMID: 15376200 DOI: 10.1002/cncr.20498] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy allows the detailed imaging and FNA not only of both intramural and extramural structures and lesions of the gastrointestinal (GI) tract but also of various intraabdominal organs. Thus, EUS-FNA biopsy offers a novel opportunity to evaluate and obtain cytology samples from adrenal gland lesions. The objective of the current study was to determine the utility of EUS-FNA in the diagnosis of adrenal lesions. METHODS The authors conducted a prospective evaluation of 24 consecutive EUS-FNA biopsy specimens obtained from patients with adrenal lesions. An attending cytopathologist was present on site to assess specimen adequacy and to provide rapid interpretation of air-dried material that had been stained with Diff-Quik (Baxter Scientific Products, McGraw Park, IL). Additional samples were obtained for ThinPrep (Cytyc Corporation, Boxborough, MA) preparation, and cell blocks subsequently were prepared. Appropriate immunohistochemical staining was performed as indicated. The cytologic diagnosis was then analyzed for correlations with the final diagnosis, which was based on relevant correlative cytologic or histologic examination of biopsied/resected pathology materials and/or final clinical follow-up. RESULTS In total, 24 EUS-FNA biopsy specimens (from 18 males and 6 females) were obtained from adrenal glands. The mean patient age was 62.2 years (range, 48-81 years). Adequate cellularity was noted in all 24 samples. Seven of 24 samples (29%) were reported to be positive for carcinoma. All samples that were diagnosed as metastatic carcinoma were confirmed on subsequent follow-up. EUS-FNA performed simultaneously with adrenal gland aspiration either from the primary site (n = 1) or from metastases to lymph nodes (n = 3) supported diagnoses of metastatic carcinoma. Six of seven samples were metastatic from the lung, and one specimen was a direct extension of a transitional renal cell carcinoma. EUS-FNA biopsy of the right adrenal gland in one patient revealed myelolipoma. In 16 patients, benign adrenal gland cells were noted on EUS-FNA biopsy specimens from enlarged adrenal glands. In 5 samples (31%), signs of adenoma were evident. Morphology alone could not distinguish between adrenal adenoma and adrenal hyperplasia. No significant complications were reported after EUS-FNA biopsy of adrenal glands. CONCLUSIONS EUS-FNA biopsy is a highly specific and safe technique for confirming the diagnosis of carcinoma metastatic to the adrenal glands. Along with cytologic evaluation, EUS imaging is needed to support the diagnosis of adrenal adenoma.
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Affiliation(s)
- Nirag C Jhala
- Department of Pathology, University of Alabama-Birmingham, Birmingham, Alabama 35249, USA.
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Mansmann G, Lau J, Balk E, Rothberg M, Miyachi Y, Bornstein SR. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev 2004; 25:309-40. [PMID: 15082524 DOI: 10.1210/er.2002-0031] [Citation(s) in RCA: 532] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinically inapparent adrenal masses are incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. They have frequently been referred to as adrenal incidentalomas. In preparation for a National Institutes of Health State-of-the-Science Conference on this topic, extensive literature research, including Medline, BIOSIS, and Embase between 1966 and July 2002, as well as references of published metaanalyses and selected review articles identified more than 5400 citations. Based on 699 articles that were retrieved for further examination, we provide a comprehensive update of the diagnostic and therapeutic approaches focusing on endocrine and radiological features as well as surgical options. In addition, we present recent developments in the discovery of tumor markers, endocrine testing for subclinical disease including autonomous glucocorticoid hypersecretion and silent pheochromocytoma, novel imaging techniques, and minimally invasive surgery. Based on the statements of the conference, the available literature, and ongoing studies, our aim is to provide practical recommendations for the management of this common entity and to highlight areas for future studies and research.
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Affiliation(s)
- Georg Mansmann
- Department of Endocrinology, Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
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Kocijancic K, Kocijancic I, Guna F. Role of sonographically guided fine-needle aspiration biopsy of adrenal masses in patients with lung cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:12-16. [PMID: 14705172 DOI: 10.1002/jcu.10220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The aims of this retrospective study were to determine the accuracy and safety of sonographically guided fine-needle aspiration biopsy (FNAB) in evaluating enlarged adrenal glands in patients with lung cancer and to correlate the metastatic involvement of the adrenal glands with the surgical stage of the primary lung tumor. METHODS During an 11-year period, 64 patients with cytologically proven lung cancer had undergone sonographically guided FNABs of an adrenal mass. The accuracy of this method was assessed on the basis of cytologic findings and the safety, on the number of complications reported after FNAB. The location of the adrenal metastasis relative to the primary tumor (ipsilateral, contralateral, or bilateral) was correlated with the surgical stage of the disease. RESULTS FNAB results were accurate in 58 of the 64 cases (91%), and the procedure was associated with no serious complications. In 6 (9%) of the 64 patients, the FNAB specimen had been inadequate. Cytologic analysis of the aspirates revealed malignancy in 52 (90%) of the 58 patients in whom the FNAB specimen had been adequate for an accurate diagnosis. The adrenal metastases were ipsilateral in 21 patients, contralateral in 15, and bilateral in 16, for an ipsilateral-to-contralateral ratio of 1.4:1. Among patients with operable disease, an ipsilateral pattern of metastasis was present in 65%, whereas among those with inoperable disease, the ipsilateral pattern was present in only 31%. The difference between these 2 groups was statistically significant (p < 0.05). CONCLUSIONS Sonographically guided FNAB is accurate and safe for evaluating enlarged adrenal glands in patients with lung cancer. Our results also suggest that a solitary ipsilateral adrenal metastasis in a patient with resectable primary lung cancer may represent a regional extension of the disease rather than systemic spread.
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Affiliation(s)
- Ksenija Kocijancic
- Clinical Center, Institute of Radiology, Zaloska 7, SI-1000 Ljubljana, Slovenia
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Kievit J, Haak HR. Diagnosis and treatment of adrenal incidentaloma. A cost-effectiveness analysis. Endocrinol Metab Clin North Am 2000; 29:69-90, viii-ix. [PMID: 10732265 DOI: 10.1016/s0889-8529(05)70117-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Methods of meta-analysis, decision analysis, and cost-effectiveness analysis were applied to the adrenal incidentaloma dilemma. It was shown that the life expectancy of patients with adrenal incidentalomas is decreased by a mean of about 1 year if left undiagnosed and untreated--more in cases of larger incidentalomas. Overall, selective analysis of adrenomedullary hormonal function (by urinary metanephrines) is the most cost-effective strategy. Other strategies, such as more extensive hormonal testing, imaging, and fine needle aspiration cytology may provide better cost-effectiveness in subgroups of patients, identified by signs, symptoms, and incidentaloma morphology. Full adrenal hormonal analysis is indicated in patients with larger (> or = 6 cm) incidentalomas and if the combination of hypertension and hypokalemia suggests Conn's disease. Small or medium-sized adrenal incidentalomas may be ignored if MR imaging or other tests suggest benign pheochromocytoma disorder, or patients are elderly, or both.
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Affiliation(s)
- J Kievit
- Medical Decision Making Unit, Leiden University Medical Center, The Netherlands.
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Abstract
"Interventional ultrasound," defined as any diagnostic and therapeutic procedure performed under ultrasound guidance was first introduced in Europe, where its early development took place in Vienna, in Copenhagen, in Italy and in Switzerland. However, many of the applications of interventional ultrasound have been based on important pioneer work using other less-suitable needle guiding methods from the pre-ultrasound era. The European contributions to "interventional ultrasound" have especially been in the development of new puncture equipment, in the dissemination of various biopsy techniques, and draining procedures and, more recently, in the development of many different tissue-ablation techniques. The above contributions, which are outlined in this historical review, have, together with significant contributions from the rest of the world-not least from the United States and Japan-created a most efficient diagnostic as well as therapeutic tool for the benefit of our patients.
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Affiliation(s)
- H H Holm
- Department of Ultrasound, Herlev Hospital, University of Copenhagen, Denmark
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Besso JG, Penninck DG, Gliatto JM. Retrospective ultrasonographic evaluation of adrenal lesions in 26 dogs. Vet Radiol Ultrasound 1997; 38:448-55. [PMID: 9402712 DOI: 10.1111/j.1740-8261.1997.tb00870.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A review was performed of ultrasonographic findings in 26 dogs with confirmed adrenal lesions. Adrenal shape, size, echogenicity, laterality, and the presence of vascular invasion were evaluated. Histopathologic diagnoses were obtained in all dogs. Adrenal lesions were confirmed as pheochromocytomas (9), adenocarcinomas (6), a poorly differentiated blastoma (1), bilateral adrenal metastases of a carcinoma (1), adenomas--one of which was bilateral--(4) and hyperplasia (6). Size and shape were extremely variable and not specific to lesion type. There was a tendency for pheochromocytomas (7), adenocarcinomas (5) and poorly differentiated blastoma (1) to be rounded masses. Adenomas (4), hyperplasia (7) and adrenal metastases (2) presented predominantly as nodules. No specificity in echogenicity was noted. Mineralization and bilaterality were present in both benign and malignant lesions. Vascular extension or the presence of a thrombus were suggestive but not specific signs of malignancy. Based on our preliminary study, ultrasonography is an effective method for localizing adrenal lesions and is helpful in assessing their extension. However, no definitive differentiation between benign and malignant lesions was possible using ultrasonographic criteria alone.
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Affiliation(s)
- J G Besso
- Department of Surgery, Tufts University School of Veterinary Medicine, North Grafton, Ma 01536, USA
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Suen KC, Chan NH. Fine needle aspiration biopsy of the adrenal gland: Cytological features and clinical applications. Endocr Pathol 1992; 3:173-181. [PMID: 32138416 DOI: 10.1007/bf02921359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The ability to visualize the adrenal glands with modern imaging techniques has improved our detection of small adrenal masses. In cancer patients, metastatic tumors to the adrenal glands are common, but not all adrenal masses are metastases. Percutaneous fine needle aspiration biopsy can be used in distinguishing metastatic malignancies to the adrenal glands from primary adrenal lesions. In our series we achieved a success rate of 86% in obtaining cellular material for diagnosis. A diagnosis of metastatic malignancy obviates the need for surgical intervention and is essential for staging and therapeutic planning. Primary adrenal cortical masses with benign cytology and under 5 cm in size can be managed conservatively with follow-up scans; those with atypical cytology or greater than 5 cm in size warrant surgical exploration. Adrenalectomy is the treatment of choice for any adrenal tumor associated with endocrine abnormality, irrespective of tumor size and cytology.
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Affiliation(s)
- Kenneth C Suen
- Department of Pathology, Vancouver General Hospital, 855West 12th Avenue, V5Z 1M9, Vancouver, BC, Canada
| | - Norman H Chan
- St. Paul's Hospital (NHC), University of British Columbia, Vancouver, BC, Canada
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Goerg C, Schwerk WB, Wolf M, Havemann K. Adrenal masses in lung cancer: sonographic diagnosis and follow-up. Eur J Cancer 1992; 28A:1400-3. [PMID: 1515257 DOI: 10.1016/0959-8049(92)90529-b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasound has become an important diagnostic modality in the staging of patients with lung cancer. Between 1980 and 1990, 410 patients with histologically proved lung cancer were evaluated. In 44 patients (11%) an adrenal mass was discovered on ultrasound; in 13 patients it was isolated, and in 31 further evidence of abdominal disease was shown. Sonographic follow-up examinations of adrenal masses showed changes of size in all but 2 patients, and were therefore found to be adrenal metastases. In the 2 patients with isolated and stable adrenal disease, fine-needle biopsy revealed adenomas. Adrenal masses in patients with lung cancer are more likely to be metastatic than benign. The existence of neoplastic adrenal disease can be retrospectively confirmed by changes of size during sonographic follow-up examinations in almost all patients. Histologically verification would only appear necessary in stable adrenal disease and in cases with isolated adrenal disease in which prompt diagnosis affects treatment decision.
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Affiliation(s)
- C Goerg
- Department of Hematology/Oncology, Philipps-University, Marburg, Germany
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López JM, Fardella C, Arteaga E, Michaud P, Rodriguez JA, Cruz F. Adrenal macrotumors diagnosed by computed tomography. J Endocrinol Invest 1990; 13:581-5. [PMID: 2172357 DOI: 10.1007/bf03348629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
UNLABELLED Adrenal tumors larger than 6 cm are unusual but show a greater incidence of malignant etiologies than smaller adrenal tumors. The scarce information about adrenal macrotumors (AMT) induced us to study prospectively all patients who were seen in our clinic during the period 1984-1988 and were diagnosed by computed tomography (CT) to have an adrenal mass greater than or equal to 6 cm. The clinical characteristics, including the main complaint, tumoral secretory activity, CT findings and histologic diagnosis from 18 patients are described; they represented a 0.3% of the total amount of abdominal CT studies performed. Seventy-two % of AMT resulted to be non cortisol or catecholamines secreting masses, and from them, a 38% corresponded to malignant etiologies characterized by marked and rapid weight loss. Four out of five hormone secreting AMT corresponded to pheochromocytomas, while the fifth one resulted to be a bilateral macronodular hyperplasia secreting cortisol. In two cases AMT did not correspond to a genuine adrenal mass, resulting to be a malignant histocytoma in one case and a hydatidic cyst in other one. When performed in two occasions, a percutaneous needle biopsy was a valuable diagnostic tool, permitting to diagnose a lymphoma and a tuberculoma. IN CONCLUSION 1) AMT correspond mainly to non cortisol or catecholamines secreting tumors, often malignant; 2) not all AMT diagnosed by CT correspond to true adrenal masses; 3) percutaneous needle biopsy can be a helpful procedure for diagnosing nonfunctioning solid AMT.
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Affiliation(s)
- J M López
- Department of Endocrinology, School of Medicine, Catholic University of Chile, Santiago
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Affiliation(s)
- R M Koenker
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston 02114
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Brabrand K, Søreide JA. Adrenal cortical carcinoma with invasion into the inferior vena cava. Br J Surg 1987; 74:598-9. [PMID: 3620869 DOI: 10.1002/bjs.1800740719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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