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

Abstract

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.

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

“…Inclusion criteria and definition of reference standard differed from the imaging meta-analysis mainly in population selection criteria (as adrenal biopsy is not indicated in incidentaloma population but rather in patients at high risk for malignancy) and in reference standard (where we accepted imaging and clinical follow-up in addition to histopathology, as most metastases would not undergo adrenalectomy). We identified 32 studies (90,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140) with a total of 2174 patients which reported at least one outcome of interest (complication rate, nondiagnostic rate, diagnostic accuracy parameters). Of these, only 8 studies (90,126,127,130,131,132,133,140) were included for the diagnostic accuracy analysis, reasons for exclusion being lack of any or optimal reference standard for at least 50% patients (n = 20) and more than 30% patients with nonadenomas in benign cohort (n = 4).…”

Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

“…Hydrodissections maneuver may also be utilized to displace structures such as vessels and bowel loops, creating a safe access route for biopsy. Such a technique has already been described for other locations such as adrenal and mediastinal lesions (13,14) .…”

EUS FNA of Altered Left Adrenal Gland Morphology Suggests Amending CT and PET-CT Attenuation Threshold Values That Predict Malignancy

“…Thus, complications such as perinephric hemorrhage, pneumothorax (5% risk) and hemothorax rarely develop. In addition, EUS does not require a saline injection to expand the posterior paravertebral space to facilitate sampling as used by some radiologists [45]. The advantages of EUS must be weighed against the cost differential and considered in the context of local expertise.…”