Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis

Abstract

Background and Objective: The role of EUS-FNA biopsy (EUS-FNAB) for detection of metastatic lesions (mets) to adrenals has not been evaluated systematically. Our aim is to systematically evaluate the performance characteristics of EUS-FNAB in detecting metastasis to the adrenal glands. Materials and Methods: We performed a systematic search on PubMed and OvidSP from January 1990 to July 2016 using various search terms for EUS and adrenal lesion. Only articles published in English literature were included in the study. Studies with fewer than 10 patients were excluded from the study. Publication bias was assessed using Begg-Mazumdar test and visual inspection of funnel plots. Results: Eight studies including 360 adrenal lesions that underwent EUS-FNAB were identified. Of these, 137 FNABs were conclusive for malignancy. Sensitivity of EUS-FNAB in detecting metastasis to the adrenals was 95% (95% confidence interval [CI]: 90%–98%) and specificity was 99% (95% CI: 96%–100%). Pooled positivity of EUS-FNAB in detecting lung cancer metastasis to the adrenals was 44% (95% CI: 31.5%–57.3%). No evidence of publication bias was noted. Conclusion: Our study demonstrates that EUS-FNAB is highly sensitive and specific in detecting metastasis to adrenals. It also shows that up to about half of the patients with lung cancer and adrenal lesions on imaging have metastasis, a finding with profound implications on lung cancer staging and treatment.

Clinical impact of endoscopic ultrasound in the study of adrenal gland: Cytomegalovirus infection mimicking a neoplasic hypercaptation in PET

“…The presence of an adenoma in left AG could have caused a false-positive in initial PET, but after ganciclovir treatment, no abnormal metabolic activity was detected in control PET. To our knowledge, this is the first case reported in the literature of unilateral CMV infection of AG in a non-HIV infected that have been diagnosed by EUS-FNA (1)(2)(3) . Given that PET scan hypercaptation is not always diagnostic of malignancy, it is mandatory to obtain pathological samples, of which EUS-FNA has proven the best technique (3) .…”

An international, multi-institution survey on performing EUS-FNA and fine needle biopsy

“…Most current studies show results similar to the ones on this survey. For SMT lesions, suspected lymphomas, solid pancreatic masses, liver lesions, left adrenal gland lesions, and lymph nodes, histological evaluation has been recommended,[ 2 3 4 ] with the further possibility of performing immunohistochemical, phenotyping, or genetic analyses. For the above lesions, some studies have also demonstrated that FNB has advantages in tissue acquisition.…”

Advances in the diagnosis and treatment of achalasia of the cardia: A review

“…EUS is widely used in the diagnosis and treatment of digestive tract diseases, as it allows for a clear view of the layered structure and thickness of the esophageal wall. [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ] This has unique diagnostic value for submucosal lesions, as it enables the identification of pseudo AC or secondary AC caused by venous tumors, neurofibroma, cicatricial stenosis, systemic sclerosis, sarcoidosis, or malignant neoplasms, reducing the likelihood of misdiagnosis and mistreatment. EUS can also be performed before and after POEM to determine the required degree of muscularis propria division.…”