Department of Gastroenterology and Hepatology, University of Alabama in Birmingham, Birmingham, Alabama, USA.
Gastrointest Endosc. 2010 Apr;71(4):745-53. doi: 10.1016/j.gie.2009.10.022. Epub 2010 Feb 13.
EUS-guided FNA of the left and right adrenals has been described, but data are very limited.
Our primary objective was to determine the impact of the diagnostic utility of EUS-guided FNA of adrenal glands on patient management. Our secondary objective was to determine predictors of malignant adrenal involvement.
Observational study.
Tertiary referral center.
Patients with enlarged adrenal(s) on abdominal imaging underwent EUS-guided FNA. The left adrenal (n = 54) was sampled via the transgastric approach and the right adrenal (n = 5) via a transduodenal approach.
Fifty-nine patients (63% men, median age 65 years) were evaluated. The median adrenal gland size was 25 x 17 mm. Adrenal tissue adequate for interpretation was obtained in all of the patients. EUS-guided FNA confirmed malignancy in 22 (37%) patients. Based on size (> or =30 mm) alone, EUS had an accuracy of 68%. Patients with malignant cytology had higher standard uptake value scores on positron-emission tomography compared with patients with benign adrenal masses (P < .001). Malignant masses were more likely to have an altered adrenal gland shape compared with benign masses (crude odds ratio [OR] 12.0; P < .001). On multivariable analysis, altered adrenal gland shape was a significant predictor of malignancy (adjusted OR 7.94; P = .015), whereas a size of 30 mm or larger (adjusted OR 1.30; P = .774) and hypoechoic nature (adjusted OR 12.05; P = .148) were not. All patients except 2 with malignant cytology were treated with systemic therapy without the need for additional invasive biopsies or surgery. No immediate complications were encountered.
Lack of surgical criterion standard; 1 experienced endosonographer.
EUS-guided FNA of the adrenal glands is a minimally invasive and safe approach that documents or excludes malignant involvement. EUS-guided FNA should be the first next test to evaluate enlarged adrenal glands because it directs therapy and affects patient management.
已经描述了超声内镜引导下左、右肾上腺的细针抽吸活检，但数据非常有限。
我们的主要目的是确定超声内镜引导下肾上腺细针抽吸活检对患者管理的诊断效用的影响。我们的次要目的是确定恶性肾上腺受累的预测因素。
观察性研究。
三级转诊中心。
腹部影像学检查发现肾上腺增大的患者接受了超声内镜引导下细针抽吸活检。左肾上腺（n=54）通过经胃途径和右肾上腺（n=5）通过经十二指肠途径进行采样。
共评估了 59 名患者（63%为男性，中位年龄 65 岁）。肾上腺大小中位数为 25×17mm。所有患者均获得可用于解释的足够的肾上腺组织。超声内镜引导下细针抽吸活检证实 22 例（37%）患者为恶性。仅根据大小（≥30mm），超声内镜的准确性为 68%。恶性细胞学患者的正电子发射断层扫描标准摄取值评分高于良性肾上腺肿块患者（P<.001）。与良性肿块相比，恶性肿块更有可能改变肾上腺的形状（未经调整的优势比[OR] 12.0；P<.001）。多变量分析显示，改变的肾上腺形状是恶性的显著预测因素（调整后的 OR 7.94；P=.015），而大小为 30mm 或更大（调整后的 OR 1.30；P=.774）和低回声性质（调整后的 OR 12.05；P=.148）不是。除了 2 例细胞学恶性患者外，所有患者均接受了全身治疗，无需进一步的侵入性活检或手术。没有发生即时并发症。
缺乏手术标准；只有 1 名经验丰富的超声内镜医师。
超声内镜引导下肾上腺细针抽吸活检是一种微创、安全的方法，可以确定或排除恶性受累。超声内镜引导下细针抽吸活检应作为评估肾上腺增大的首选下一步检查，因为它指导治疗并影响患者管理。
