Introduction
The role of fine needle aspiration (FNA) biopsy in patients with incidentally discovered
adrenal masses is limited. However, image-guided biopsy continues to be performed
in this setting, in some cases before biochemical workup. The purpose of this study
was to review the value of FNA biopsy of adrenal masses in patients referred to a
large university endocrine surgical practice.
Methods
Patients referred to the endocrine surgery service at our institutions from 1997 through
2006 for evaluation of an adrenal mass were identified and those who underwent needle
biopsy were selected for analysis.
Results
Of the 347 patients evaluated for adrenal masses, 22 (6.3%) had undergone needle biopsy
before referral. Clinical presentations were incidentaloma (n = 15), suspected metastasis (n = 4), and symptomatic large mass (n = 3). In 10 cases, a radiology report had either suggested a biopsy or stated that
the mass was “amenable” to biopsy. In the 15 patients with incidentaloma, 12 (80%)
had nondiagnostic biopsy results and 2 showed pheochromocytoma. Biopsies were diagnostic
in 2 of 4 patients with suspected metastasis and in 1 of 3 patients with a large symptomatic
mass. There were 3 biopsy-related complications: 1 liver hematoma, 1 hemothorax, and
1 duodenal hematoma. No biochemical testing for pheochromocytoma was performed before
biopsy in 10 patients, 5 of whom were ultimately diagnosed with pheochromocytoma.
Biopsy results did not alter clinical management in any of the 22 patients in this
study.
Conclusions
FNA biopsy is not useful in the diagnostic workup of patients with incidentally discovered
adrenal masses and rarely alters management in patients with resectable adrenal metastases
and primary adrenal malignancies. Furthermore, biopsy in this setting can also be
potentially hazardous. Language that suggests biopsy of adrenal masses should be avoided
in radiology reports.
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Article info
Publication history
Accepted:
July 1,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
