Prospective evaluation of unilateral adrenal masses in patients with operable non-small-cell lung cancer.

Abstract

Although adrenal metastases are frequently noted with non-small-cell lung cancer (NSCLC) at autopsy, their incidence in patients with operable NSCLC is unclear. We prospectively assessed consecutive patients with otherwise operable NSCLC for the incidence and histology of unilateral adrenal masses. Assessment included blood chemistries, lung function tests, bronchoscopy, chest x-ray, bone scan, and computed tomography (CT) of the head, chest, and upper abdomen. Of 246 patients with otherwise operable NSCLC, 10 (4.1%) had a unilateral adrenal mass. Unilateral adrenal masses were needle-aspirated under CT control. If cytology was nondiagnostic, adrenalectomy was performed. Four (40%) of 10 patients had adrenal metastases proven by needle aspiration. Of the six (60%) patients with benign unilateral adrenal masses, one was demonstrated by needle aspiration. In the other five patients, a nondiagnostic needle aspiration led to adrenalectomy, which yielded two adenomas, two hyperplastic nodules, and one hemorrhagic cyst. There was no significant difference between the patients with benign and metastatic unilateral adrenal masses with respect to patient age or stage and size of adrenal mass. Patients with benign unilateral adrenal masses underwent curative resection of their NSCLC and had significantly prolonged survival compared with patients with metastatic unilateral adrenal masses treated with chemotherapy (P = .037). Median survival of patients with benign and metastatic unilateral adrenal masses was greater than 30 months and 9 months, respectively. In conclusion, the presence of unilateral adrenal masses in patients with otherwise operable NSCLC should not preclude thoracotomy without pathologic proof of metastatic disease.

Endoscopic ultrasound-guided fine-needle aspiration biopsy of the adrenal glands

“…10 -12,25 In patients who are evaluated for staging of operable nonsmall cell lung carcinoma accompanied by adrenal gland enlargement, a nondiagnostic FNA sample may have far-reaching implications, including the possible recommendation of adrenalectomy. 26 In addition to the experience of the operator, another possible explanation for the increased sample yield in the current study is that a cytopathologist always was present on-site for the assessment of sample adequacy. Like us, Fassina et al, 10 in their study of image-guided FNA biopsy of the adrenal gland, suggested that the increased specimen adequacy rate observed (108 of 119 [91%]) could be attributed to the presence of a cytopathologist whose duty was to assess specimen adequacy.…”

The role of positron emission tomography with18F-fluoro-2-deoxy-D-glucose in respiratory oncology

“…The ®nding of an isolated adrenal mass on CT is often a diagnostic challenge. About two-thirds of cases could be explained by an asymptomatic adrenal adenoma in some series [110,113]. An adrenal mass, therefore does not imply inoperable disease, but rather the need for further (pathological) examination by, for example, puncture or biopsy of the lesion [113].…”

Adrenal Oligometastases Secondary to Non-small Cell Lung Cancer—What is the Optimal Treatment Approach?

“…46,47 Historically, the MS of patients with an AM, in whom it and the primary are left in situ, is 9 months. 22 Five-year OS is essentially zero in the absence of an actionable molecular mutation. 4 There is no randomized evidence supporting the use of any AM-directed therapy, and no prospective studies directly comparing surgery and SBRT.…”