Percutaneous Adrenal Biopsy for Indeterminate Adrenal Lesion: Complications and Diagnostic Accuracy

Osman, Yasser; El-Mekresh, Mohsen; Gomha, Abdul-Monem; Mohsen, Tarek; Taha, Noheir M; Hussein, Naser; Eraky, Ibrahim

doi:10.1159/000288235

Cited by 19 publications

(21 citation statements)

References 27 publications

(39 reference statements)

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“…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).…”

Section: Value Of An Adrenal Biopsy (Question 1b)mentioning

confidence: 99%

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

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,310

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Value Of An Adrenal Biopsy (Question 1b)mentioning

confidence: 99%

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

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,310

1,571

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“…The size is a problem in adrenal oncocytic neoplasms because most oncocytic adrenal tumors, although benign, Review display a large volume [46] . A preoperative percutaneous biopsy [47] , by means of CT or ultrasound scan guidance, provides an accurate diagnosis in some cases of indeterminate mass, with a sensitivity of 73.3%. Careful biochemical analyses should be undertaken to rule out the presence of a primary functioning mass which requires surgical resection despite the size: some cases of adrenal oncocytic neoplasm have presented as functioning tumors.…”

Section: Diagnosismentioning

confidence: 99%

Adrenal Oncocytic Neoplasm: A Systematic Review

Mearini¹,

Sordo

Costantini³

et al. 2012

Urol Int

102

151

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Introduction: Oncocytic neoplasms as tumors arising in the adrenal glands are rare, usually considered as nonfunctional and benign. In the current literature, there are extremely limited reports of adrenal oncocytic neoplasms; as to date, only 147 cases have been described. The rarity of the event prompted this study which reviews and presents the incidence, histology, diagnosis and therapy of adrenal oncocytic neoplasms. Materials and Methods: A review by systematic literature search was done using the MEDLINE®/Cochrane libraries from 1950 to date using the medical subject headings ‘oncocytoma', ‘adrenal gland', ‘adrenal oncocytoma', ‘adrenal oncocytic neoplasm' and ‘adrenal oncocytic carcinoma'. Results: Adrenal oncocytic neoplasm is a rare disease, usually incidentally detected because only 17% are functional adrenal masses. The typical oncocyte displays abundant granular eosinophilic cytoplasm, due to the accumulation of mitochondria. Computed tomography and magnetic resonance imaging are not able to identify or differentiate benign and malignant oncocytic neoplasms. The mainstay of therapy is adrenalectomy, recently performed by laparoscopy. The prognosis is good for benign tumors, while adrenocortical oncocytic carcinoma has a poor survival rate of only 5 years. Conclusions: Adrenal oncocytic neoplasm, a rare and mostly benign tumor, usually presents as an incidental, large adrenal mass; surgery is the mainstay of therapy, by means of laparoscopy which is now the most diffuse approach to adrenalectomy.

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“…Adrenal biopsy complications vary in severity with both immediateand delayed-onset complications as described previously (16,17,18). In addition, if clinicians fail to biochemically exclude the presence of pheochromocytoma before biopsy, an unplanned biopsy of a catecholamine-producing tumor can result in severe complications (19,20).…”

Section: Introductionmentioning

confidence: 93%

“…Of the 175 studies, 95 were excluded based on abstract screening and the remaining 80 full-text papers were reviewed. Of these, 32 studies (7,8,9,10,13,16,17,19,21,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42) reported at least one outcome of interest and were included. Studies were primarily excluded due to no outcome of interest (n = 19), <10 patients (n = 12), abstract only without subsequent full paper publication (n = 8), patient overlap (n = 7), ex vivo biopsy (n = 1), and case-control study (n = 1).…”

Section: Included Studiesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

Bancos

Tamhane

Shah

et al. 2016

European Journal of Endocrinology

113

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Objective: To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy. Methods: Medline In-Process and Other non-Indexed citations, MEDLInE, EMBAsE, and cochrane central Register of controlled Trial were searched from inception to february 2016. Reviewers extracted data and assessed methodological quality in duplicate. Results: We included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%cI: 6-11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%cI: 1.5-3.4%). studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively. Conclusions: Evidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

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Percutaneous Adrenal Biopsy for Indeterminate Adrenal Lesion: Complications and Diagnostic Accuracy

Cited by 19 publications

References 27 publications

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

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

Adrenal Oncocytic Neoplasm: A Systematic Review

DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis

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