Endocrine Abstracts

Background: The accuracy of the radiological and laboratory findings used to investigate adrenal masses are not optimal and therefore additional investigation methods, such as fine needle aspiration (FNA) are sometimes needed. Different methods are used for obtaining FNA such as endoscopic ultrasound (EUS), transabdominal ultrasound and computerized tomography (CT)-guided biopsy.

Methods: Using a search function incorporated in our institutional pathology database, patients who underwent FNAs of adrenal glands at Karolinska University Hospital, Stockholm Sweden between the years 2007-2019 were identified. Medical records for these patients were scrutinized from clinical, radiological, and cytological perspectives. Data included gender, age at time of FNAB, primary origin of the original tumor, uni- or bilateral disease, metastasis to other organs, tumor size, patient outcome during the observation time including survival, adequacy of the sample as well as subsequent histological diagnosis.

Results: A total of 139 adrenal FNAs were identified. Of those, 54 (38.8%) were obtained by EUS, 52 (37.4%) by transabdominal ultrasound and 26 (18.7%) were CT-guided. Preceeding radiological investigation suspected malignant lesions in 107 cases (77%). Adequate material for diagnosis was retrieved in 52 cases (96.3%) by EUS, 47 cases (90.4%) by transabdominal ultrasound and in 22 cases (84.6%) by CT-guided biopsies. By FNA adrenal lesions were diagnosed as distant metastasis in 82 cases (59%), adrenocortical cells were found in 54 cases (38.8%) and the diagnosis was unclear in 3 cases (2.2%). Of those in which adrenal cells were identified 5 were later diagnosed as adrenal cortical cancer (3.6%). Most metastases were from lung cancer (48 cases, 58.5%) followed by malignant melanoma (5 cases, 6.1%), renal cancer (4 cases, 4.9%), gynecological cancer (4 cases, 4.9%), and other malignancies (21 cases, 25.6%) (e.g., breast, prostate, hepatocellular, and gastrointestinal cancer). Complications due to the biopsy procedure such as bleeding and pneumothorax were reported in 10 cases (7.2%).

Conclusions: FNA of the adrenal glands is safe and provides useful information in diagnosis of adrenal tumors. Complications are rare regardless of method used. Overall adequacy rate for adrenal biopsy were high, with the EUS having the best results.

Keywords: fine needle aspiration, adrenal glands.