Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) in the Diagnosis of Adrenal Metastasis in a High-Risk Population

Presentation Number: SUN 384
Date of Presentation: April 2nd, 2017

Catherine D. Zhang*, Dana Erickson, Michael J. Levy, Ferga C. Gleeson, Danae Anastasia Delivanis and Irina Bancos
Mayo Clinic, Rochester, MN


Background: The adrenal gland is a common site of metastasis, and tissue sampling is often needed to confirm malignant involvement. While the left adrenal gland is readily accessible via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), data regarding the utility of EUS-FNA in the diagnosis of adrenal lesions remain limited.

Aim: To describe the clinical context, adverse event rate, and diagnostic performance of adrenal EUS-FNA. A secondary aim was to compare the safety profile and diagnostic accuracy of EUS-FNA with percutaneous US and/or CT guided biopsy.

Materials and Methods: From a prospectively maintained EUS database, we identified all patients from 01/2005-06/2016 in whom adrenal EUS-FNA was performed. Biopsy outcomes were evaluated using a pre-defined reference standard based on strict clinical, radiological, and/or surgical follow up. Results were compared to a cohort of patients who underwent percutaneous adrenal biopsy (n=419, 1994-2014).

Results: A total of 121 patients [53% female, median age 68 years (range 33-101)] underwent EUS-FNA of 122 adrenal lesions [left-sided (n=121), right-sided (n=1), mean lesion size 1.8 cm (range 0.5-5.0)]. The cytology specimens were interpreted as benign/negative in 84 (69%), atypical in 3 (2%), and positive for metastasis in 35 [29%: non-small cell lung cancer (n=25), esophageal adenocarcinoma (n=3), pancreatic adenocarcinoma (n=3), small cell lung cancer (n=1), breast cancer (n=1), renal cell carcinoma (n=1), and neuroendocrine tumor (n=1)]. No adverse events were reported. EUS-FNA diagnosed adrenal metastasis with a sensitivity of 100% (95% CI 72-100%), specificity of 97.4 % (95% CI 87-100%), PPV of 91.7% (95% CI 62-100%), and NPV of 100% (95% CI 91-100%). When compared to percutaneous adrenal biopsy performed at the same institution, lesion size [1.8 cm vs 3.7 cm, P <0.001) and biopsy site (99% left adrenal vs 62% left adrenal, P <0.001] were significantly different. The adverse event rate of EUS-FNA was lower than percutaneous adrenal biopsy (0% vs 4%, P=0.024), but non-diagnostic rates were similar (3.3% vs 4.8%, P=0.48).

Conclusion: EUS-FNA is a safe and sensitive technique to sample left adrenal lesions in patients at high-risk for adrenal metastasis with fewer adverse events compared to percutaneous biopsy.


Nothing to Disclose: CDZ, DE, MJL, FCG, DAD, IB