Adrenal Biopsy Research Articles

Primary adrenal insufficiency due to bilateral infiltrative disease.

Evidence on clinical presentation, evaluation, and management of patients with primary adrenal insufficiency (PAI) due to bilateral adrenal infiltrative disease is scarce. Our objective was to review the clinical presentation, biochemical work-up, imaging findings, and management of patients with PAI due to infiltrative adrenal disease in order to determine the best diagnostic and management approach. Retrospective study of patients with PAI due to bilateral infiltrative adrenal disease referred for adrenal biopsy during 2000-2014 at Mayo Clinic, Rochester, Minnesota. Two additional patients evaluated after 2014 were included. Seven patients (six males and one female) were diagnosed with PAI caused by bilateral adrenal infiltrative disease at a median age of 54 (range 36-80) years. Duration of symptoms prior to the diagnosis of PAI and initiating treatment was 6 months (range 3 months-4 years). All patients demonstrated bilateral adrenal masses on adrenal imaging. The underlying diagnosis was confirmed by histopathology and included: bilateral adrenal metastases (lung and breast adenocarcinoma), diffuse large B-cell lymphoma, tuberculosis, cryptococcus, histoplasmosis, and, Erdheim-Chester disease. In patients with newly diagnosed PAI, the differential diagnosis should include bilateral infiltrative adrenal disease, especially when testing for autoimmune adrenalitis is negative, or if there is clinical history suggesting another etiology. Patients who present with known bilateral adrenal infiltrative disease should be counseled and tested for PAI periodically, particularly if presenting with suggestive signs or symptoms.

Transesophageal approach to lung, adrenal biopsy and fiducial placement using endoscopic ultrasonography (EUS): An interventional pulmonology experience. Initial experience of the UCSF-FRETOC (fresno tracheobronchial & oesophageal center) study group.

Routine lung cancer surveillance has resulted in early detection of pulmonary nodules and masses. Combined endobronchial ultrasound (EBUS) and trans-esophageal endoscopic ultrasound (EUS) are approved methods for sampling lymph nodes or masses. Furthermore, EUS allows for adrenal sampling as part of staging, and can assist with fiducial placement for stereotactic body radiation therapy (SBRT). Promote use of EUS by interventional pulmonologists in the United States when diagnosing and staging lung cancer or when placing fiducials. All patients undergoing EUS and/or EBUS were serially entered into a prospectively maintained database. Only patients undergoing EUS guided lung and/or adrenal biopsy and/or fiducial placement were selected for analysis. All patients underwent a post-procedure chest radiograph and were followed outpatient. 20 of 39 patients underwent sampling of a suspicious lung mass. An adequate sample was obtained in 19 of 20 patients. In all 19 patients a definitive diagnosis was achieved (95%). In all 13 patients who underwent adrenal sampling, presence or absence of metastasis was conclusively established. 6 patients successfully underwent fiducial placement. In all 39 patients, no major procedure related complications were noted for a period of 30 days. One patient had a small pneumothorax that resolved spontaneously. EUS can be safely performed by a trained interventional pulmonologist for the diagnosis of lung, adrenal masses and placement of fiducials. We think that interventional pulmonologists in the United States involved in lung cancer staging should receive training in EUS techniques.

Adrenal Biopsy under Wide-Bore MR Imaging Guidance

Twenty-four magnetic resonance (MR) imaging–guided percutaneous adrenal biopsies performed between April 2009 and October 2016 were reviewed retrospectively. Epidemiologic, procedural, and histopathologic data were retrospectively collected. Mean size of tumors was 4.3 cm (range, 1.5–16.0 cm). Mean procedure time was 49 min (range, 24–95 min). Mean needle angulation was 27.7° (range, 0°–60°). Mean depth was 9.6 cm (range, 5.8–13.7 cm). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR imaging–guided biopsy were 95.5%, 100%, 100%, 66.7%, and 95.8%, respectively. There were no immediate or delayed complications. MR imaging guidance seems safe and accurate to target adrenal-gland masses.

Bilateral Primary Adrenal Lymphoma in a 59- year-old Female

Occasionally, lymphoma involves the adrenal glands; however, primary adrenal lymphoma (PAL) is rare and only few cases have been reported. We report a case of a 59-year-old female with primary adrenal diffuse large B-cell lymphoma (DLBCL) manifested by weakness, fatigue, anorexia, and hyper pigmentation of skin. The patient initially responded to intravenous hydrocortisone in large doses by total remission of the symptoms. An abdominal computed tomography scan showed a hypodense mass in the right subdiaphragmatic space, which was suggestive of an adrenal gland tumor with adjacent liver involvement. Additionally, a smaller lesion with similar characteristics was found in the left adrenal gland. The results obtained from adrenal gland needle biopsy confirmed the diagnosis of DLBCL. Moreover, primary laboratory findings demonstrated hyponatremia, hyperkalemia, fasting blood sugar level of 153 mg/dl, and alkaline phosphatase level of 663 U/L. The mentioned symptoms and laboratory findings were indicative of adrenal insufficiency. After about 2 months, her level of consciousness decreased and urinary and fecal incontinence occurred. Therefore, brain involvement was suspected, and magnetic resonance imaging of the brain showed heterogeneous enhancement (24.8 mm) in the posterior aspect of the left temporal lobe together with patchy foci of enhancement in around the ventricular areas of the brain that showed metastatic lesions of PAL. This case should remind clinicians that PAL may be a cause of adrenal incidentaloma, especially when the patient presents with the symptoms of adrenal insufficiency.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Diagnosis of Adrenal Metastasis in a High-Risk Population

While the left adrenal gland is readily accessible via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), data regarding the utility of EUS-FNA in the diagnosis of adrenal lesions remain limited. We aimed to ( 1) describe the clinical context, adverse event rate, and diagnostic performance of EUS-FNA, and ( 2) compare the safety profile and diagnostic accuracy of EUS-FNA with percutaneous adrenal biopsy. Single-center, retrospective cohort study. Medical records of patients who underwent adrenal EUS-FNA from 2005-2016 were reviewed. Biopsy outcomes were evaluated using a predefined reference standard. Results were compared to patients who underwent percutaneous biopsy (n = 419; 1994-2014) at the same institution. A total of 121 patients underwent EUS-FNA of 122 adrenal lesions (left [n = 121]; right [n = 1]; mean lesion size, 1.8 cm). Cytology was positive for malignancy in 35 (29%), suspicious for malignancy in 1 (1%), atypical in 1 (1%), negative for malignancy in 81 (66%), and nondiagnostic in 4 (3%). No adverse events were reported. EUS-FNA diagnosed metastasis with a sensitivity of 100%, specificity of 97.4%, positive predictive value of 91.7%, and negative predictive value of 100%. When compared to percutaneous biopsy, lesion size (1.8 cm vs. 3.7 cm; P<.001) and biopsy site (99% vs. 62% left adrenal; P<.001) were significantly different. EUS-FNA adverse event rate was lower than percutaneous biopsy (0% vs. 4%; P = .024), but nondiagnostic rates were similar (3.3% vs. 4.8%; P = .48). EUS-FNA is a sensitive technique to sample adrenal lesions in patients at high risk for adrenal metastasis with fewer adverse events compared to percutaneous biopsy. CI = confidence interval CT = computed tomography EUS-FNA = endoscopic ultrasound-guided fine-needle aspiration NPV = negative predictive value PPV = positive predictive value TUS = transabdominal ultra-sound.

Rare cause of adrenal insufficiency

A 72-year-old man presented with weight loss, night sweats and haemoptysis and was hypotensive. CT imaging showed rapidly enlarging bilateral adrenal masses, and he was found to have primary adrenal...

Diagnostic performance of unenhanced computed tomography and 18 F-fluorodeoxyglucose positron emission tomography in indeterminate adrenal tumours.

Evidence on the diagnostic performance of adrenal imaging is limited. We aimed to assess the diagnostic performance of unenhanced computed tomography (CT) and 18 F-fluorodeoxyglucose (18 FDG) positron emission tomography (PET)/CT imaging in a high-risk population for adrenal malignancy using an optimal reference standard. Retrospective cohort study. Imaging studies of patients with adrenal nodules who underwent adrenal biopsy and/or adrenalectomy between 1994 and 2014 were reviewed and compared to the reference standard of histology. Eighty % of patients presented with known or suspected extra-adrenal malignancy. Unenhanced abdominal CT was performed in 353 patients with adrenal lesions; median size was 3 (0.7-15) cm and median radiodensity was 33 (-21-78) Hounsfield units (HU). Radiodensity of >10HU diagnosed malignancy with a sensitivity of 100%, specificity of 33%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 100%. 18 FDG-PET/CT was performed in 89 patients; median tumour size was 2.1 (0.7-9.2) cm. Maximum standardized uptake (SUV max) was higher in malignant lesions when compared to benign lesions (median=10 [2.3-29.4] vs 3.7 [1.4-24.5], respectively, P<.0001). Similarly, median SUV max lesion to SUV max liver ratio (ALR) in malignant lesions was higher than in benign lesions (median=3 [0.74-13.4] vs 1.2 [0.5-6.6], respectively, P<.0001). 18 FDG-PET/CT ALR >1.8 diagnosed malignancy with a sensitivity of 87%, specificity of 84%, PPV of 85% and NPV of 86%. Noncontract CT radiodensity of ≤10HU excludes malignancy even in a high-risk population. For indeterminate adrenal lesions, given a superior specificity, 18 FDG-PET/CT could be considered as a second stage imaging study.

Primary adrenal lymphoma with initial presentation concerning for bilateral adrenal pheochromocytomas

Primary adrenal non-Hodgkin’s lymphoma is rarely encountered. Clinical presentation is non-specific with fatigue, abdominal pain and B-symptoms being more commonly reported. We report a case of primary bilateral adrenal lymphoma...

Preoperative adrenal biopsy does not affect overall survival in adrenocortical carcinoma

BackgroundThe impact of preoperative biopsy on overall survival (OS) in adrenocortical carcinoma (ACC) is unclear. We analyzed the National Cancer Data Base (NCDB) for factors associated with preoperative adrenal biopsy and its effect on OS in ACC. MethodsThe NCDB was queried from 2003 to 2012 for M0 ACC. Patients with or without preoperative biopsy were compared for factors associated with an increased rate of biopsy. Survival analysis was performed after adjusting for patient and tumor-related variables. ResultsThere were 1782 patients with M0 ACC of whom 332 (19%) had a preoperative biopsy. Treatment outside academic cancer centers (OR 1.36, 95% CI 1.04–1.77, P = 0.023) and male gender (OR 1.45, 95% CI 1.11–1.88, P = 0.006) were associated with an increased rate of biopsy. In patients undergoing adrenalectomy with negative margins, biopsy failed to impact OS (log-rank P = 0.225, HR 1.20, 95% CI 0.84–1.72, P = 0.306). ConclusionsPreoperative adrenal biopsy continues to be performed for ACC with no added survival benefit. Adrenalectomy offers the best chance of survival in patients with ACC.

A Rare Case of Primary Bilateral Adrenal Lymphoma

Lymphoma may involve the adrenal glands, but primary lymphoma is rare. Only a few cases have been reported in medical literature. Primary adrenal lymphoma is extremely rare, accounting for <1% of non-Hodgkin lymphomas. We here present a case of a middle-aged female who presented with persistent fever for three weeks. She also reported significant weight loss of more than 10 kgs over the duration of three months. Computed tomography of the thorax and abdomen and pelvis demonstrated bilateral adrenal masses. She underwent short Synacthen test which showed evidence of adrenal insufficiency. She underwent CT-guided adrenal gland biopsy. Histology of adrenal gland biopsy showed features consistent with diffuse large B-cell lymphoma. She was started on R-CHOP chemotherapy and had a good clinical response and remained in complete remission for five months after chemotherapy.

C-arm cone-beam computed tomography with stereotactic needle guidance for percutaneous adrenal biopsy: initial experience.

Background Metastasis to the adrenal glands is frequent in patients with various cancers and adrenal gland biopsy is routinely performed using ultrasound or computed tomographic (CT) guidance. However, this method is technically challenging, especially in the case of small masses. Purpose To determine whether the new real-time stereotactic needle guidance technique C-arm cone-beam CT (CBCT) allows safe and accurate biopsy of adrenal gland masses, especially those in hard-to-reach anatomical locations. Material and Methods CBCT guidance was used to perform 60 stereotactic biopsy procedures of lesions that were inaccessible with ultrasound or CT guidance. The needle path was carefully planned and calculated on the CBCT virtual navigation guidance system, which acquired 3D CT-like cross-sectional images. The adrenal biopsy procedures were performed with fluoroscopic feedback. Technical success rate, sensitivity, specificity, accuracy, and complications were investigated. Results The technical success rate of adrenal biopsy under CBCT virtual navigation was 100%, with a mean total procedure time of 14.6 ± 3.6 min. Of the 60 lesions, 46 were malignant, 11 were benign, and three were non-diagnostic. The three non-diagnostic lesions proved to be malignant. Thus, the sensitivity, specificity, and accuracy were 93.8%, 100%, and 95.0%, respectively. Minor bleeding occurred in two (3.3%) cases. Conclusion CBCT guidance allows safe and accurate biopsy of adrenal gland masses and may be especially useful for hard-to-reach anatomical locations.

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

The role of percutaneous adrenal biopsy in a high-risk population for adrenal malignancy has not been fully investigated. Our aim was to describe the clinical presentation leading to the adrenal biopsy and evaluate the diagnostic performance, complications and non diagnostic rate of adrenal biopsy. Single-centre, retrospective cohort study. Medical records of patients who underwent adrenal biopsy between 1994 and 2014 were reviewed. Adrenal biopsy outcome was compared to a predefined reference standard. Biopsy was performed in 418 patients [62% men, median age 69 years (range, 15-91)] on 419 adrenal lesions, median size 3·1 cm (range, 0·6-24). The main indication for adrenal mass biopsy was (349/419, 83%) suspected adrenal metastasis from a known or suspected extra-adrenal primary source. Only 116 of 419, 28% of cases had prebiopsy biochemical testing for pheochromocytoma. Biopsy-related complications occurred in 4% of the patients. Histology revealed a metastasis in 231 of 419 (55%), benign adrenal tissue in 137 of 419 (33%), adrenocortical carcinoma in eight of 419 (2%), other lesions in 23 of 419 (5%) including seven cases of pheochromocytoma and six cases of infectious process. Biopsy was nondiagnostic in 20 of 419 (5%). All adrenal masses with unenhanced radiodensity ≤10 HU (42/137, 31%) proved to be benign adrenal adenomas. Adrenal biopsy diagnosed malignancy with a sensitivity of 88·5%, specificity of 91·5%, positive predictive value of 93·4% and negative predictive value of 85·5%. When used in the appropriate clinical setting, adrenal biopsy is a powerful tool in the diagnostic algorithm of the evaluation of adrenal masses with features suspicious for malignancy. Efforts to increase awareness to perform biochemical testing for pheochromocytoma prior to adrenal biopsy are needed.

DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis.

To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy. Medline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate. We included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6-11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5-3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively. Evidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.

4:03 PMAbstract No. 373 - Predictive value of image-guided percutaneous adrenal biopsy in patients with a new or suspected diagnosis of lung cancer

4:03 PMAbstract No. 373 - Predictive value of image-guided percutaneous adrenal biopsy in patients with a new or suspected diagnosis of lung cancer

Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration.

A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types.

Adrenal Imaging: Magnetic Resonance Imaging and Computed Tomography.

The adrenal glands are located superior to the kidneys and play an important role in the endocrine system. Each adrenal gland contains an outer cortex, responsible mainly for the secretion of androgens and corticosteroids, and an inner medulla, which secretes epinephrine and norepinephrine. Here, we review the anatomy of the adrenal glands and explain the current imaging modalities that are most useful for the assessment of the various conditions--both benign and malignant--that can affect these glands. As adrenal lesions are often identified incidentally on cross-sectional imaging performed for other reasons, the management of such adrenal 'incidentalomas' is also discussed. In many cases, adrenal lesions have distinctive imaging features that allow for a full characterization with noninvasive techniques. In some cases, invasive studies such as adrenal vein sampling or adrenal biopsy become necessary. This review should give the reader a wide overview of how various imaging techniques can be useful in the assessment of adrenal pathology.

Visual Vignette

Case Presentation: A 55-year-old female with type 2 diabetes and hypertension was initially seen for evaluation of a physical exam remarkable for a dorsocervical fat pad, moon facies, abdominal striae, and hirsutism. An elevated morning cortisol level of 24.8 μg/dL (normal: 4.3–22.4 μg/dL) was subsequently found. Further biochemical evaluation revealed a 24-hour urinary free cortisol of 302 μg/24 hours (normal: 3.5–45 μg/24 hours), an inappropriately normal adrenocorticotropic hormone (ACTH) level of 49 pg/mL (normal: 6–58 pg/mL), and a 1-mg overnight dexamethasone suppression test with a cortisol level of 31.9 mcg/dL (normal: <1.8 μg/dL). An abdominal computed tomography (CT) scan (Fig. 1) showed normal adrenal glands with no hyperplasia or nodules, and pituitary magnetic resonance imaging (MRI) showed a partially empty sella without evidence of an adenoma. She was lost to follow-up, so treatment was not initiated for the ACTH-dependent Cushing syndrome. Six years later, she was admitted for septic shock with a morning cortisol level of 3.2 μg/dL and ACTH of 82 pg/mL. Stress dose steroids were started. Pituitary MRI was negative for pituitary adenoma or hemorrhage. Abdominal CT scan (Fig. 2) showed diffusely enlarged adrenal glands, each measuring 6 cm. A follow up brain MRI showed a small focus of hypoenhancement. Notably, her calcium level was 15.8 mg/dL (normal: 8.4–10.2 mg/dL). An adrenal biopsy was performed, and the histology sample stained with lactophenol cotton blue (Fig. 3). What is the diagnosis?

Molecular-genetic diagnosis of a Bulgarian family with multiple endocrine neoplasia, type IIA

INTRODUCTION : Multiple Endocrine Neoplasia (MEN) is a rare autosomal dominant disease with frequency 1:30 000 and it is classified in 3 subtypes: MEN 2A (Sipple syndrome), familial medullary thyroid carcinoma (FMTC), MEN 2B. The MEN 2A subtype constitutes approximately 70%-80% of cases of MEN 2. The onset age of the MEN 2A is prior to age 35 years. MEN 2A has an increased risk for parathyroid hyperplasia or adenoma. The clinical diagnosis is suspected when at least 2 specific endocrine tumors are detected in one patient or close relatives (MTC, pheochromocytoma, parathyroid adenomas). MTC is suspected in case of increased serum levels of calcitonin. The biochemical phenotype of MTC is revealed between age 5 and 25 (mean age 15 years). The tumor formation in the neck area is between age of 15 and 20 (2). Although there is controversy surrounding the definition of CCH, its utility to identify or confirm MEN 2 has been essentially replaced by RET (REarranged during Transfection) protooncogene testing. This allows the early surgery interventions, proper genetic counseling and prenatal diagnostics. MATERIAL AND METHODS : We report on a Caucasian male with complains of general weakness and weight loss (10 kg for 2 month). The patient`s mother has been diagnosed at 47 as bilateral pheochromocytomas and struma nodosa and died at age of 51. In the index patient abdominal ultrasound examination with biopsy of adrenal glands and histological analysis revealed pheochromocytoma on the right side; elevated plasma calcitonin concentration and US scan with biopsy of thyroid tissue detected medular thyroid cancer. The index patient has two elder brothers - it turned out that one of them had been surgically treated for medular thyroid cancer in the past; bilateral pheocromocytomas were detected in the family screening process. RESULTS AND CONCLUSION : MEN 2A diagnosis was suspected and we performed sequencing of RET protooncogene. The genetic analysis of the family affected members revealed c.1902C>G, p.Cys634Trp heterozygous mutation. Unfortunately, two kids in the families of 2 of the brothers have also inherited the mutation. All adult family members were offered genetic counseling. The standard therapy and the prophylactic thyroidectomy include the surgical removal of the thyroid gland, followed by parathyroid gland autotransplantation. In case codon 634 mutation the surgery is recommended before age of 5 years. All affected relatives are going through monitoring for residual disease. The screening protocol includes plasma levels of calcitonin. The stimulation tests are more sensitive than calcitonin measurements alone so they are recommended.

664. Improving AAV Gene Therapy Safety Analysis: Multiplex LAM-PCR Provide New Insights Into AAV Vector Integration

Nowadays, recombinant adeno-associated viruses (rAAV) constitute one of the most successful vectors for human gene therapy. These viral vectors allow a long-term transgene expression mainly due to their ability to form stable concatemeric DNA structures. Interestingly, although it is a rare event, rAAV have been shown to randomly integrate into the host genome.The inverted terminal repeats (ITR) have been shown to be preferred breakage points within the rAAV vectors. Current analysis of AAV integration are based on the linear amplification mediated (LAM)-PCR technology, here the genomic regions adjacent to the ITRs are amplified and sequenced for the determination of the integration sites (IS). However, recent studies have shown that vector breakage may also occur along the whole vector sequence, thus requiring the development of new methods able to identify the integration of internal vector regions.We present a novel method for the detection of rAAV integration based on the LAM-PCR technology by employing simultaneously five primer sets covering the whole AAV vector sequence. This multiplex LAM-PCR was used, in parallel with the standard 5’ LAM-PCR, in liver, spleen and adrenal gland biopsies from monkeys injected with 1×1013 viral genomes (vg)/kg or 5×1013 vg/kg of the AAV2/5-AAT-coPBGD vector (this vector has been used in a phase I clinical trial for acute intermittent porphyria). Subsequent 454 sequencing and data analysis of ≈1 million raw sequences for each tissue allowed the identification of near 800 integration sites (IS). As it has been previously reported, vector integration occurs within different regions of the ITR, although preferentially in the C-region. In addition, multiplex LAM-PCR showed breakage at different positions of the AAV vector genome in all the organs analyzed.Our data show the increased sensitivity of this method and its suitability for the analysis of viral integration occurring at inner regions of the rAAV vector. Thus, this new method will provide a deeper insight into the interaction of AAV vectors with the host genome and will contribute to increase the thoroughness of the safety studies for the increasing number of gene therapy clinical trials using rAAV vectors.

Is endoscopic ultrasonography-guided fine needle aspiration trailblazing in tissue sampling of adrenal masses?

Is endoscopic ultrasonography-guided fine needle aspiration trailblazing in tissue sampling of adrenal masses?