Use and Usefulness of Adrenal Core Biopsies Without FNA or On-site Evaluation of Adequacy

Abstract

While several studies have assessed the efficacy of adrenal fine-needle aspiration, there are few data regarding adrenal tissue core biopsies. We performed a retrospective study, for a 12-year period, of 204 percutaneous adrenal core biopsy specimens. A core was the only specimen obtained, and on-site evaluation was not used. About half of the cases (104/204) were diagnosed as metastatic carcinoma, with lung as the most common origin (78/204). A specificity and sensitivity of 100% for benign vs malignant was calculated, with a specificity of 88% and sensitivity of 86% for specific diagnoses. Diagnostic and sampling errors were identified. False-negatives were limited to biopsies using 20-gauge needles. Cases with a clinical history provided had specific diagnoses made at a slightly higher frequency compared with cases without an available history. Immunohistochemical workup was performed in more than half of the cases; specific diagnoses were made more frequently than in cases without immunostains.

Fluorodeoxyglucose-Positron-Emission Tomography/Computed Tomography Imaging for Adrenal Masses in Patients with Lung Cancer: Review and Diagnostic Algorithm

“…35,46 These nondiagnostic FNA concerns were recently addressed in a study of more than 200 adrenal core biopsies. 47 In this selected population of cancer patients, adrenal biopsies positive for metastatic carcinoma were almost always accurate (positive predictive value of 96%). ''Benign'' biopsies, however, had a negative predictive value of 58%, which led the authors to conclude that a negative large core biopsy may not always rule out malignancy.…”

Procedural and clinical outcomes of percutaneous adrenal biopsy in a high‐risk population for adrenal malignancy

“…A comparable prevalence of metastases was described in other smaller studies reporting an overall experience with adrenal biopsy. [19][20][21] In studies reporting almost exclusively on oncologic patients, a higher prevalence of metastases of up to 78-81% has been described. 22,23 Interestingly, even in patients with 'benign' imaging characteristics (i.e.…”

Adrenal Imaging Features Predict Malignancy Better than Tumor Size

“…Risks of the procedure can also be problematic and include hemorrhage, pneumothorax, needle track seeding, especially if ACC is biopsied, and unintentional biopsy of pheochromocytoma, which can be dangerous. 20 Core biopsies also have limited usefulness with sensitivity and specificity of 86 and 88 %, respectively. 20 The role of preoperative percutaneous biopsy is limited to the clinical scenario that requires definitive diagnosis for cancer staging and treatment planning.…”

“…20 Core biopsies also have limited usefulness with sensitivity and specificity of 86 and 88 %, respectively. 20 The role of preoperative percutaneous biopsy is limited to the clinical scenario that requires definitive diagnosis for cancer staging and treatment planning. Pheochromocytoma should always be excluded before any biopsy.…”