CT-guided adrenal biopsy: accuracy, safety, and indications

Bernardino, ME; Mm, Walther; Vm, Phillips; Graham, SD; Cw, Sewell; Gedgaudas-McClees, K; Br, Baumgartner; Torres, W E; Erwin, B C

doi:10.2214/ajr.144.1.67

Cited by 132 publications

(48 citation statements)

References 8 publications

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“…Studies reported a sensitivity of 81-96% and a specificity of 99-100% to identify malignant masses. Inconclusive biopsies were reported in 6-50% of samples (68)(69)(70). Complications of fine needle aspiration biopsy (FNAB) have not been adequately reported in all studies; however, the rate of adverse events is ranging from 2.8 to 14%.…”

Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

456

412

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Objective: To assess currently available evidence on adrenal incidentaloma and provide recommendations for clinical practice. Design: A panel of experts (appointed by the Italian Association of Clinical Endocrinologists (AME)) appraised the methodological quality of the relevant studies, summarized their results, and discussed the evidence reports to find consensus. Radiological assessment: Unenhanced computed tomography (CT) is recommended as the initial test with the use of an attenuation value of %10 Hounsfield units (HU) to differentiate between adenomas and non-adenomas. For tumors with a higher baseline attenuation value, we suggest considering delayed contrast-enhanced CT studies. Positron emission tomography (PET) or PET/CT should be considered when CT is inconclusive, whereas fine needle aspiration biopsy may be used only in selected cases suspicious of metastases (after biochemical exclusion of pheochromocytoma). Hormonal assessment: Pheochromocytoma and excessive overt cortisol should be ruled out in all patients, whereas primary aldosteronism has to be considered in hypertensive and/or hypokalemic patients. The 1 mg overnight dexamethasone suppression test is the test recommended for screening of subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l for considering this condition. A value of 50 nmol/l virtually excludes SCS with an area of uncertainty between 50 and 138 nmol/l. Management: Surgery is recommended for masses with suspicious radiological aspects and masses causing overt catecholamine or steroid excess. Data are insufficient to make firm recommendations for or against surgery in patients with SCS. However, adrenalectomy may be considered when an adequate medical therapy does not reach the treatment goals of associated diseases potentially linked to hypercortisolism.

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Section: Epidemiologymentioning

confidence: 99%

AME Position Statement on adrenal incidentaloma

Terzolo

Stigliano

Chiodini

et al. 2011

European Journal of Endocrinology

456

412

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“…So long as the resolution of the adrenal glands is concerned, CT is more preferable. Even small tumors, not visualized by US, can be monitored for puncture by CT (Haaga 1979;Luning et al 1983;Pagani 1983;Bernardino et al 1985). US-guided adrenal biopsy is effective only for tumors larger than 2 cm in diameter, as shown in this study.…”

Section: Discussionmentioning

confidence: 51%

Percutaneous Biopsy for Adrenal Tumors Using Ultrasonically Guided Puncture.

Kojima

Saitoh

Itoh

et al. 1994

Tohoku J. Exp. Med.

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“…Image-guided percutaneous biopsy is an accurate and safe alternative to surgical biopsy for the diagnosis of pathological conditions of the adrenal gland [1][2][3]. In oncological patients even a negative result on CT-guided biopsy is reliable and can be regarded as a true negative evaluation with no need to repeat the biopsy [7].…”

Section: Discussionmentioning

confidence: 99%

“…This procedure is most often performed in patients with a suspicion of metastatic disease, where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. The usefulness of percutaneous adrenal biopsy is limited in other primary adrenal gland pathologies, such as nonfunctioning or functioning adenomas, infectious disease, adrenal haemorrhage or primary malignant tumours [1][2][3].…”

mentioning

confidence: 99%

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection—a safe and technically easy approach

Tyng

Bitencourt

Martins

et al. 2012

BJR

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ABSTRACT. The adrenal glands are an important site of both primary and secondary disease processes. Image-guided percutaneous biopsy of the adrenal gland is an accurate and safe alternative to surgical biopsy. This procedure is most often performed in patients with a suspicion of metastatic disease where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. There are many different approaches to performing adrenal biopsy under CT guidance such as anterior transhepatic/transpancreatic, lateral transhepatic/transplenic or posterior transpulmonary/transpleural/paravertebral. We describe a technique in which the adrenal gland was biopsied using a CT-guided percutaneous paravertebral approach with the use of a hydrodissection manoeuver. 13 CT-guided adrenal gland percutaneous biopsies using this technique were performed at our institution between April 2009 and July 2010. All biopsies yielded sufficient material for pathological analysis and there were no complications reported after the procedure. Saline injection can expand the posterior paravertebral space and facilitate a posterior extrapleural approach with high accuracy and low complication rates, and we believe that this may be the best approach for adrenal gland biopsy.

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CT-guided adrenal biopsy: accuracy, safety, and indications

Cited by 132 publications

References 8 publications

AME Position Statement on adrenal incidentaloma

AME Position Statement on adrenal incidentaloma

Percutaneous Biopsy for Adrenal Tumors Using Ultrasonically Guided Puncture.

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection—a safe and technically easy approach

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