Endoscopic Ultrasound-Guided Fine Needle Aspiration of the Left Adrenal Gland in Patients with Thoracic or Gastrointestinal Malignancies

Abstract

Background: The diagnostic yield and safety of trans-gastric Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the left adrenal gland is not well defined. Methods: All patients with an enlarged left adrenal gland on abdominal imaging with known or suspected malignancy who were referred to one of two EUS centers over a three year period were included in this study. EUS-FNA was performed on an outpatient basis by one of four experienced endosonographers. Results: Thirty-one consecutive patients (68% male, mean age of 64.8 years) were evaluated. Adequate tissue for interpretation was obtained in all patients with no failed attempts. The median number of passes was 4.5 (range 1-8) and no immediate complications were encountered. EUS-FNA confirmed malignant adrenal involvement in 42% (13/31) of the cases. Patients with malignant left adrenal masses were more likely to have known cancer at another site (OR = 12.0; 95% CI = 1.6 - 87.9). Patients with benign masses were more likely to have preservation of the normal appearance of the adrenal gland (“Seagull” configuration) compared to those with malignant masses (OR = 9.8; 95% CI = 1.9 - 51.0). The accuracy of EUS imaging based on size (=3cm) alone was 81% (95% CI: 63-93). Eighty five percent (11/13) of patients with malignant adrenal masses died or had clinical deterioration at follow-up while 15% (2/13) had a stable clinical condition on treatment. Conclusion: EUS-FNA of the left adrenal gland is a minimally invasive, safe and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or gastrointestinal malignancies.