EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies☆
Received 21 October 2003; received in revised form 22 December 2003; accepted 21 January 2004.
Abstract
Background
The diagnostic yield and safety of trans-gastric EUS-guided FNA of the left adrenal gland are not well defined.
Methods
All patients with an enlarged left adrenal gland on abdominal imaging and known or suspected malignancy referred to two EUS centers over a 3-year period were included in this study. EUS-guided FNA was performed on an outpatient basis by one of 4 experienced endosonographers.
Results
Thirty-one consecutive patients (21 men, 10 women; mean age 64.8 years) were evaluated. Tissue adequate for interpretation was obtained in all patients; no attempt to obtain tissue was unsuccessful. The median number of needle passes was 4.5 (range 1-8). No immediate complications were encountered. EUS-guided FNA confirmed malignant left adrenal involvement in 42% (13/31) of the patients. Patients with malignant left adrenal masses were more likely to have known cancer at another site (OR 12.0: 95% CI[1.6, 87.9]). Patients with benign masses were more likely to have preservation of the normal sonographic appearance of the adrenal gland (“seagull” configuration) compared with those with malignant masses (OR 9.8: 95% CI[1.9, 51.0]). The accuracy of EUS imaging based on size (≥3 cm) alone was 81%: 95% CI[63, 93]). Of the patients with malignant adrenal masses, 85% (11/13) died or their clinical condition deteriorated during follow-up, while 15% (2/13) were being treated and were stable clinically.
Conclusions
EUS-guided FNA of the left adrenal gland is a minimally invasive, safe, and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or GI malignancies.
Birmingham, Alabama, and Hamburg, Germany
Current affiliations: Department of Medicine, The Division of Gastroenterology and Hepatology, Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany, and Institute of Cytology, Hannover, Germany
Reprint requests: Mohamad A. Eloubeidi, MD, MHS, Director, Endoscopic Ultrasound Program, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, 1530 3rd Ave. S. - ZRB 636, Birmingham, AL 35294-0007.
☆ These authors contributed equally to the manuscript
ABSTRACT