Left Adrenal Biopsy Using the Convex Curvilinear Ultrasound Scope

Meena, Nikhil; Hulett, Cidney; Jeffus, Susanne K.; Bartter, Thaddeus

doi:10.1159/000368370

Cited by 21 publications

(27 citation statements)

References 20 publications

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“…A recently published small (n = 6) case series in selected lung cancer patients showed that the LAG can be identified and sampled using an EBUS scope [23]. However, to date, the feasibility and technique of LAG assessment using the EBUS scope is unknown.…”

Section: Introductionmentioning

confidence: 99%

Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial

Crombag

Annema²

2016

Respiration

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Background: In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. Objectives: The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. Methods: We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. Results: A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. Conclusions: The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. Implication: In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.

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Section: Introductionmentioning

confidence: 99%

Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial

Crombag

Annema²

2016

Respiration

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“…The most common solid tumor documented to spread to the adrenal gland in our series was lung carcinoma. The literature suggests that up to 10% of patients with lung carcinoma who are thought to be resectable at the time of diagnosis (those without N2 disease) are found by imaging to have occult adrenal involvement, and up to 42% will develop adrenal metastases as their diseases progress . A relevant confounding fact is that 3%‐7% of the entire adult population is known to harbor incidental adrenal masses, most commonly asymptomatic cortical adenomas .…”

Section: Discussionmentioning

confidence: 99%

“…17 metastases as their diseases progress. 18,19 A relevant confounding fact is that 3%-7% of the entire adult population is known to harbor incidental adrenal masses, most commonly asymptomatic cortical adenomas. 15 We found 6% of aspirated lesions to be primary neoplasms, in keeping with these previously reported findings.…”

Section: Methodsmentioning

confidence: 99%

Fine‐needle aspiration of adrenal lesions: A 20‐year single institution experience with comparison of percutaneous and endoscopic ultrasound guided approaches

Novotny

Reynolds

Shah

et al. 2019

Diagnostic Cytopathology

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Background Historically, sampling of adrenal lesions has been performed by percutaneous image‐guided fine‐needle aspiration (FNA) biopsy. Endoscopic ultrasound guided (EUS)‐FNA of the adrenals was first employed at Cleveland Clinic ~10 years ago. We report a two‐decade experience of adrenal FNA in our institution. Methods An electronic retrieval identified adrenal FNAs from 1997 to 2017. Data points from each case (diagnosis, method of FNA, age, sex, laterality, needle gauge, size of lesion, adequacy of sample, and histologic follow up) were analyzed. Results Our retrieval confirmed 198 adrenal FNAs performed over 20 years. Of these, 90% (179/198) were percutaneous, and the remaining 10% (19/198) were collected by EUS. Of the 179 CT guided FNAs, 93% (162/179) yielded an adequate specimen as compared with an adequacy rate of 89% (17/19) for EUS‐FNAs, with no significant difference in adequacy rates by collection method, P = .64 (Fisher's exact). Of all adrenal FNAs, 53% (105/198) confirmed metastases, 33% (65/198) showed adrenal cells or primary adrenal neoplasms (85% cortical cells, 14% cortical neoplasia, 1% pheochromocytoma), 8% were inadequate (15/198), 3% were atypical (7/198), and 2% were suspicious for malignancy (5/198). Conclusion FNA of the adrenal glands can be useful in the diagnosis and staging of metastatic neoplasms, as well as in distinguishing primary adrenal cortical from medullary neoplasms and characterizing hematolymphoid and mesenchymal neoplasms. Overall adequacy rates for adrenal cytology are high (92%) with no statistically significant difference between CT‐guided (93%) and EUS‐FNA adequacy (89%). The majority of our procedures confirmed metastases, sparing patients unnecessary surgery.

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“…In this issue of Respiration , Meena et al [6] suggest a further role for the EBUS scope in the diagnostic work-up of cancers, which goes beyond the current indications, and, in fact, for the first time, beyond the thorax. They report a successful series of biopsies from enlarged left adrenal glands using the convex curvilinear EBUS scope.…”

mentioning

confidence: 99%

“…Moreover, when performed by pulmonologists in a lung cancer setting, the combination with EBUS-TBNA allows a complete evaluation of tumor extent during the same procedure because of the complementary reach of different targets [8]. In this scenario, using a single scope to perform both EBUS and EUS, as proposed by Meena et al [6], could further optimize the cost-effectiveness of the preoperative assessment, which would easily fit with daily clinical practice due to the widespread lack of time and resources.…”

mentioning

confidence: 99%