Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses

Background and study aim: Although the left adrenal gland is readily visible by endoscopic ultrasound (EUS), there are few published data on the utility of EUS-guided fine-needle aspiration (EUS-FNA) of this site. The aim of this study was to report our experience of EUS-FNA of left adrenal gland masses.

Patients and methods: In this retrospective case series, we reviewed our EUS and cytology databases to identify consecutive patients who underwent EUS-FNA of the left adrenal gland between January 1997 and January 2004. Medical records were reviewed and the results of EUS examinations and cytological investigations were abstracted.

Results: Our searches resulted in the identification of a series of 38 consecutive patients who underwent EUS for the evaluation of a lung mass (n = 14), a pancreatic mass (n = 14), obstructive jaundice (n = 1), dysphagia (n = 2), an ampullary adenoma (n = 1), celiac block (n = 1), or a left adrenal gland mass (n = 5). The mean maximal left adrenal mass diameter was 24 mm (range 7-66 mm). Diagnoses after EUS-FNA (the mean number of passes was 3.6) were: metastatic lung cancer (n = 2), esophageal adenocarcinoma (n = 1), melanoma (n = 1), renal cell carcinoma (n = 1), and pancreatic neuroendocrine tumor (n = 1); primary pheochromocytoma (n = 1); benign adrenal tissue (n = 21); and granulomatous inflammation (n = 1). Nine aspirations (24 %) were nondiagnostic. The absence of a discrete adrenal mass on EUS occurred more frequently in patients with nondiagnostic biopsies than in those with diagnostic biopsies (56 % vs. 7 %; odds ratio 23.4, 95 %CI 3.5 - 157.0; P = 0.004). No complications were noted.

Conclusions: EUS-FNA of the left adrenal gland is safe and can be useful for the evaluation and staging of suspected malignancy. Nondiagnostic biopsies are more common when sampling diffusely enlarged glands, compared with glands with a focal mass.

References

• 1 Grumbach M M, Biller B M, Braunstein G D. et al . Management of the clinically inapparent adrenal mass (”incidentaloma”).  Ann Intern Med. 2003;  138 424-429
• 2 Silverman S G, Mueller P R, Pinkney L P. et al . Predictive value of image-guided adrenal biopsy: analysis of results of 101 biopsies.  Radiology. 1993;  187 715-718
• 3 Harisinghani M G, Maher M M, Hahn P F. et al . Predictive value of benign percutaneous adrenal biopsies in oncology patients.  Clin Radiol. 2002;  57 898-901
• 4 Goerg C, Schwerk W B, Wolf M. et al . Adrenal masses in lung cancer: sonographic diagnosis and follow-up.  Eur J Cancer. 1992;  28A 1400-1403
• 5 Lumachi F, Borsato S, Brandes A A. et al . Fine-needle aspiration cytology of adrenal masses in noncancer patients: clinicoradiologic and histologic correlations in functioning and nonfunctioning tumors.  Cancer. 2001;  93 323-329
• 6 Gillams A, Roberts C M, Shaw P. et al . The value of CT scanning and percutaneous fine needle aspiration of adrenal masses in biopsy-proven lung cancer.  Clin Radiol. 1992;  46 18-22
• 7 Mody M K, Kazerooni E A, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications.  J Comput Assist Tomogr. 1995;  19 434-439
• 8 Dietrich C F, Wehrmann T, Hoffmann C. et al . Detection of the adrenal glands by endoscopic or transabdominal ultrasound.  Endoscopy. 1997;  29 859-864
• 9 Giovannini M, Seitz J F, Monges G. et al . Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
• 10 Chang K J, Erickson R A, Nguyen P. Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration of the left adrenal gland.  Gastrointest Endosc. 1996;  44 568-572
• 11 Wallace M B, Ravenel J, Block M I. et al . Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography.  Ann Thorac Surg. 2004;  77 1763-1768
• 12 Ringbaek T J, Krasnik M, Clementsen P. et al . Transesophageal endoscopic ultrasound/fine-needle aspiration diagnosis of a malignant adrenal gland in a patient with non-small cell lung cancer and a negative CT scan.  Lung Cancer. 2005;  48 247-249
• 13 Kramer H, Groen H J. Diagnosis of mediastinal and left adrenal abnormalities with endoscopic ultrasonography.  Respir Med. 2005;  99 926-928
• 14 Eloubeidi M A, Seewald S, Tamhane A. et al . EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies.  Gastrointest Endosc. 2004;  59 627-633
• 15 Stelow E B, Debol S M, Stanley M W. et al . Sampling of the adrenal glands by endoscopic ultrasound-guided fine-needle aspiration.  Diagn Cytopathol. 2005;  33 26-30
• 16 Wu H H, Cramer H M, Kho J. et al . Fine needle aspiration cytology of benign adrenal cortical nodules: a comparison of cytologic findings with those of primary and metastatic adrenal malignancies.  Acta Cytol. 1998;  42 1352-1358
• 17 Pagani J J. Normal adrenal glands in small cell lung carcinoma: CT-guided biopsy.  AJR Am J Roentgenol. 1983;  140 949-951
• 18 Benitah N, Yeh B M, Qayyum A. et al . Minor morphologic abnormalities of adrenal glands at CT: prognostic importance in patients with lung cancer.  Radiology. 2005;  235 517-522
• 19 Casola G, Nicolet V, van Sonnenberg E. et al . Unsuspected pheochromocytoma: risk of blood-pressure alterations during percutaneous adrenal biopsy.  Radiology. 1986;  159 733-735
• 20 Akdamar M K, Eltoum I, Eloubeidi M A. Retroperitoneal paraganglioma: EUS appearance and risk associated with EUS-guided FNA.  Gastrointest Endosc. 2004;  60 1018-1021