Endoscopic Ultrasound-Guided Fine Needle Aspiration of Left Adrenal Gland Masses

Abstract

Introduction: CT-guided percutaneous FNA is traditionally used for cytologic sampling of adrenal masses. Although the left adrenal gland is readily visible by EUS imaging from the proximal stomach, there are limited published data on the utility of EUS-FNA of this site. Aim: To report our experience of EUS-FNA of left adrenal gland masses. Methods: A review of our EUS and cytology databases was conducted to determine all patients who underwent EUS-FNA of the left adrenal gland between from 1/97 to 10/03. Medical records of all subjects were reviewed and results of EUS examinations and cytology were abstracted. On-site cytopathology was present for all procedures. Results: 35 patients (20 male; mean age 64) were identified. Indications for EUS included: evaluation or staging of a lung or mediastinal mass (14), pancreatic mass (14), esophageal cancer (2), renal cell carcinoma (1), ampullary adenoma (1), chronic pancreatitis (1), left adrenal gland mass (1) or planned celiac block (1). Mean maximal adrenal mass diameter was 27 mm (range: 7-66 mm). Results of EUS-FNA: mean passes 3.6 (range: 1-7), diagnoses: metastatic small cell (1), non-small cell (1) or esophageal cancer (1), pheochromocytoma (1), adrenal adenoma or hyperplasia (7), benign adrenal tissue (14), granulomatous inflammation (1) or nondiagnostic material (9). The three patients who had metastases to the left adrenal gland were also found to have metastatic mediastinal or celiac lymph nodes confirmed by EUS-FNA. Findings of EUS-FNA could not differentiate a benign adrenal adenoma from hyperplasia. No complications from EUS-FNA were encountered. Conclusion: EUS-FNA of the left adrenal gland is useful for the evaluation of left adrenal gland masses. A thorough examination of the left adrenal gland during EUS is indicated during evaluation and staging of suspected malignancy, particulary lung cancer. A prospective study comparing EUS-FNA to CT-guided FNA of left adrenal masses is indicated.