Gupta Rakesh K, Majumdar Kaushik, Saran Ravindra K, Srivastava Siddharth, Sakhuja Puja, Batra Vineeta V
Department of Pathology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.
Department of Gastroenterology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.
J Cytol. 2018 Apr-Jun;35(2):83-89. doi: 10.4103/JOC.JOC_241_16.
Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is a precise and safe technique that provides both radiological and pathological diagnosis with a better diagnostic yield and minimal adverse events. EUS-FNAC led to the remarkable increase in the detection rate of incidentaloma found during radiologic staging or follow-up in various malignancy or unrelated conditions.
We did this preliminary study with an aim to evaluate the role of EUS-FNA in diagnosing and classifying adrenal lesions, clinical impact, and compare the outcome with the previously published literature.
We included 32 consecutive cases (both retrospective and prospective) of EUS-guided adrenal aspirate performed over a period of 3.3 years. The indications for the aspirate in decreasing order were metastasis (most common carcinoma gall bladder) > primary adrenal mass > disseminated tuberculosis > pyrexia of unknown origin. On EUS, 28 cases revealed space occupying lesion or mass (two cases bilateral) and four cases revealed diffuse enlargement (two cases bilateral) with a mean size of 21 mm.
The cytology reports were benign adrenal aspirate (43.8%), metastatic adenocarcinoma (15.6%), histoplasmosis (9.4%), tuberculosis (9.4%), round cell tumor (6.2%), adrenocortical carcinoma (3.1%), and descriptive (3.1%). Three cases (9.4%) yielded inadequate sample. The TNM staging was altered in 22.23% of the cases by result of adrenal aspirate.
EUS-FNA of the adrenal gland is a safe, quick, and sensitive and real-time diagnostic technique, which requires an integrated approach of clinician, endoscopist, and cytopathologist for high precision in diagnosis. Although the role of EUS-FNA for right adrenal is not much described, we found adequate sample yield in all the four patients that underwent the procedure.
内镜超声引导下细针穿刺抽吸细胞学检查（EUS-FNAC）是一种精确且安全的技术，可同时提供放射学和病理学诊断，诊断率更高且不良事件最少。EUS-FNAC使得在各种恶性肿瘤或无关病症的放射学分期或随访期间发现的偶发瘤的检出率显著提高。
我们开展这项初步研究旨在评估EUS-FNA在肾上腺病变诊断和分类中的作用、临床影响，并将结果与先前发表的文献进行比较。
我们纳入了在3.3年期间连续进行的32例（包括回顾性和前瞻性）EUS引导下肾上腺抽吸病例。抽吸的适应症按降序排列为转移（最常见的是胆囊癌）>原发性肾上腺肿块>播散性结核病>不明原因发热。在EUS检查中，28例显示有占位性病变或肿块（2例双侧），4例显示弥漫性增大（2例双侧），平均大小为21毫米。
细胞学报告为良性肾上腺抽吸物（43.8%）、转移性腺癌（15.6%）、组织胞浆菌病（9.4%）、结核病（9.4%）、圆形细胞瘤（6.2%）、肾上腺皮质癌（3.1%）和描述性（3.1%）。3例（9.4%）样本不足。肾上腺抽吸结果使22.23%的病例的TNM分期发生了改变。
肾上腺EUS-FNA是一种安全、快速、敏感的实时诊断技术，为实现高精度诊断，需要临床医生、内镜医生和细胞病理学家采取综合方法。尽管EUS-FNA对右侧肾上腺的作用描述不多，但我们发现接受该操作的所有4例患者均获得了足够的样本。
