Original Articles
EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies☆

https://doi.org/10.1016/S0016-5107(04)00296-2Get rights and content

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.

Section snippets

Patients and methods

The study was approved by the respective institution review boards at both participating institutions. All patients with an enlarged adrenal gland on abdominal imaging (CT, magnetic resonance imaging [MRI], and/or positron emission tomography [PET]) (Fig. 1), with known or suspected malignancy referred to two centers with EUS expertise over a 3-year period (2000-2003) were included. Data were collected prospectively as an ongoing observational study of EUS-FNA at one center (University of

Results

Over the study period, 31 patients (21 men, 10 women; median age 65 years; range 48-85 years) underwent EUS-FNA of an enlarged left adrenal gland at the two centers. The majority (24/31; 77.4%) were white (Table 1). In one patient, CT-guided FNA before EUS-FNA was unsuccessful. In another patient, the mass was not amenable to CT-guided sampling, and this patient, therefore, was referred for EUS-FNA. Tissue adequate for interpretation was obtained in all patients; no EUS-FNA was unsuccessful.

Discussion

The detection of distant metastasis in patients with lung cancer has a major impact on prognosis and management.1 Studies have shown that in patients with non-small-cell lung cancer, an isolated adrenal mass is more likely to be an adenoma, and, thus, tissue diagnosis is required before a decision against potential curative resection is made.1., 18. In addition, it cannot be assumed that an isolated adrenal mass in a patient with non-small-cell bronchogenic carcinoma represents metastasis,

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    ☆

    These authors contributed equally to the manuscript

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    Copyright © 2004 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.