Role of endoscopic ultrasound fine-needle aspiration evaluating adrenal gland enlargement or mass

AIM:To report the clinical impact of adrenal endoscopic ultrasound fine-needle aspiration(EUS-FNA)in the evaluation of patients with adrenal gland enlargement or mass.METHODS:In a retrospective single-center caseseries,patients undergoing EUS-FNA of either adrenal gland from 1997-2011 in our tertiary care center were included.Medical records were reviewed and results of EUS,cytology,adrenal size change on follow-up imaging≥6 mo after EUS and any repeat EUS or surgery were abstracted.A lesion was considered benign if:(1)EUS-FNA cytology was benign and the lesion remained<1 cm from its original size on follow-up computed tomography(CT),magnetic resonance imaging or repeat EUS≥6 mo after EUS-FNA;or(2)subsequent adrenalectomy and surgical pathology was benign.RESULTS:Ninety-four patients had left(n=90)and/or right(n=5)adrenal EUS-FNA without adverse events.EUS indications included:cancer staging or sus-pected recurrence(n=31),pancreatic(n=20),mediastinal(n=10),adrenal(n=7),lung(n=7)mass or other indication(n=19).Diagnoses after adrenal EUSFNA included metastatic lung(n=10),esophageal(n=5),colon(n=2),or other cancer(n=8);benign primary adrenal mass or benign tissue(n=60);or was non-diagnostic(n=9).Available follow-up confirmed a benign lesion in 5/9 non-diagnostic aspirates and 32/60benign aspirates.Four of the 60 benign aspirates were later confirmed as malignant by repeat biopsy,followup CT,or adrenalectomy.Adrenal EUS-FNA diagnosed metastatic cancer in 24,and ruled out metastasis in 10patients.For the diagnosis of malignancy,EUS-FNA of either adrenal had sensitivity,specificity,positive predictive value and negative predictive value of 86%,97%,96%and 89%,respectively.CONCLUSION:Adrenal gland EUS-FNA is safe,minimally invasive and a sensitive technique with significant impact in the management of adrenal gland mass or enlargement.