Safety of percutaneous ultrasound‐guided fine‐needle aspiration of adrenal lesions in dogs: Perception of the procedure by radiologists and presentation of 50 cases

Abstract

Background Percutaneous ultrasound (US)‐guided fine‐needle aspiration (FNA) of adrenal gland lesions is controversial in veterinary medicine. Objective To evaluate the frequency and radiologists' perception of the risk of the procedure as well as determining the incidence of complications. Methods Retrospective study. A first survey was submitted by e‐mail to all board‐certified radiologists of the American College of Veterinary Radiology (ACVR) and European College of Veterinary Diagnostic Imaging (ECVDI). A second survey was sent to radiologists who declared having performed the procedure at least once in their career (observational cross‐sectional case study). Results The first survey was sent to 977 diplomates and answered by 138. Of 138 diplomates, 40 currently performed the procedure and 98 did not; 44 of the 98 gave the hypertensive crisis risk in pheochromocytoma as a reason. To the second survey, 12 of 65 responded positively; 50 dogs with 58 lesions were recruited, including 23 pheochromocytomas. Complications were reported in 4 of 50 dogs; 3 hemorrhages (1 mild and 1 moderate) and 1 death from acute respiratory distress syndrome (possibly related to laryngeal paralysis). No hypertensive crisis was reported. There was no relationship between the method of FNA/type of needle used and occurrence of complications. Based on the recollection of these 65 radiologists, who performed approximately 200 FNA of adrenal lesions, a death rate of approximately 1% was estimated. Conclusions and Clinical Importance Percutaneous US‐guided FNA of adrenal lesions can be considered a minimally risky procedure, despite the negative perception by radiologists.

Prediction of vascular invasion using a 7‐point scale computed tomography grading system in adrenal tumors in dogs

“…33 These findings also corresponded to the category that was more difficult to discriminate from pheochromocytoma regarding tumor type. In this equivocal situation, ultrasound-guided fine needle aspiration of the AT may be considered because it is known as a safe technique 34,35 and cytological analysis can allow good discrimination between neuroendocrine and epithelial origin of the tumor. 36 We used a decision tree method to analyze our data.…”

Multiple endocrine neoplasia type 2‐like syndrome in a crossbred dog

“…Overall, a noninvasive diagnosis of pheochromocytoma in human patients is based on documenting abnormal regulation of catecholamines via measurement of urine and plasma metanephrine concentrations; 40 unfortunately, however, this laboratory testing is not easily available in our country. Recently, cytological examination of adrenal samples collected by FNA has been described, and published data concerning FNA of canine adrenal masses suggest a good diagnostic accuracy of adrenal cytology in distinguishing neoplasms of cortical origin from those of medullary origin as well as a low complication rate 41–43 . In the present study, cytology was useful in confirming the presence of a carcinomatous adrenal lesion, although it was not possible to differentiate pheochromocytoma from primary hyperaldosteronism.…”

“…Recently, cytological examination of adrenal samples collected by FNA has been described, and published data concerning FNA of canine adrenal masses suggest a good diagnostic accuracy of adrenal cytology in distinguishing neoplasms of cortical origin from those of medullary origin as well as a low complication rate. [41][42][43] In the present study, cytology was useful in confirming the presence of a carcinomatous adrenal lesion, although it was not possible to differentiate pheochromocytoma from primary hyperaldosteronism. The latter is an extremely rare disease in dogs, and none of the published studies about the accuracy of adrenal cytology included dogs with primary hyperaldosteronism.…”

Hypocortisolism in a dog caused by bilateral pheochromocytoma

“…Fine‐needle aspirate or adrenal biopsy could have been performed for definitive diagnosis of PCC and to exclude infiltrative causes in this case. However, because of the risk of the procedure due to the presence of arrhythmias, and the low possibility of infiltrative adrenal disease, we did not perform it 18,19 …”

“…However, because of the risk of the procedure due to the presence of arrhythmias, and the low possibility of infiltrative adrenal disease, we did not perform it. 18,19 In human medicine, adrenal biopsy is recommended whenever it is not possible to make the diagnosis by other non-invasive methods. In our case, there was no evidence of infiltrative disease, functional corticoadrenal origin had been ruled out and the urine metanephrines/creatinine ratio was extremely elevated.…”