CT-guided percutaneous core biopsy for assessment of morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer.

Abstract

Increased fludeoxyglucose(FDG) uptake in morphologically normal adrenal glands on positron emission tomography-CT (PET-CT) is a diagnostic challenge with major implications on treatment. The purpose of this retrospective study was to report our experience of CT-guided percutaneous core biopsy of morphologically normal adrenal glands showing increased FDG uptake in a context of lung cancer. Biopsies for non-enlarged adrenal glands showing increased FDG uptake in lung cancer patients performed at our institution from December 2014 to December 2016 were retrospectively analyzed. Six biopsies were performed in five patients during the study period. All procedures were performed with the patients in the prone position, using a posterior approach and coaxial 17-gauge needles with 18-gauge automated cutting needles. Patient characteristics, procedural details and final pathological diagnosis were analyzed, as well as the duration of hospitalization. Five of the six biopsies (83.3%) confirmed adrenal metastasis from the primary lung cancer. No complications were reported and the patients were discharged the day after the procedure. The high confirmation rate of metastasis and lack of complications support performing CT-guided percutaneous biopsy of non-enlarged adrenal glands showing increased FDG uptake, for optimal management in lung cancer patients. Morphologically normal adrenal glands showing high FDG uptake in patients with lung cancer are metastasis. This manuscript shows that CT-guided percutaneous biopsy should be proposed. Increased FDG uptake in morphologically normal adrenal glands may indicate metastasis.