Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA, 02120, USA.
Abdom Radiol (NY). 2024 Apr;49(4):1231-1240. doi: 10.1007/s00261-024-04211-0. Epub 2024 Mar 2.
To assess indications, safety, and effectiveness of percutaneous adrenal mass biopsy in contemporary practice.
This institutional review board-approved, retrospective study included all patients undergoing percutaneous image-guided adrenal mass biopsies at an academic health system from January 6, 2015, to January 6, 2023. Patient demographics, biopsy indications, mass size, laboratory data, pathology results, and complications were recorded. Final diagnoses were based on pathology or ≥ 1 year of imaging follow-up when biopsy specimens did not yield malignant tissue. Test performance calculations excluded repeat biopsies. Continuous variables were compared with Student's t test, dichotomous variables with chi-squared test.
A total of 160 patients underwent 186 biopsies. Biopsies were indicated to diagnose metastatic disease (139/186; 74.7%), for oncologic research only (27/186; 14.5%), diagnose metastatic disease and oncologic research (15/186; 8%), and diagnose an incidental adrenal mass (5/186; 2.7%). Biopsy specimens were diagnostic in 154 patients (96.3%) and non-diagnostic in 6 (3.8%). Diagnostic biopsies yielded malignant tissue (n = 136), benign adrenal tissue (n = 12), and benign adrenal neoplasms (n = 6) with sensitivity = 98.6% (136/138), specificity = 100% (16/16), positive predictive value = 100% (136/136), and negative predictive value = 88.9% (16/18). Adverse events followed 11/186 procedures (5.9%) and most minor (7/11, 63.6%). The adverse event rate was similar whether tissue was obtained for clinical or research purposes (10/144; 6.9% vs. 1/42; 2.4%, p = 0.27), despite more specimens obtained for research (5.8 vs. 3.7, p < 0.001).
Percutaneous adrenal mass biopsy is safe, accurate, and utilized almost exclusively to diagnose metastatic disease or for oncologic research. The negative predictive value is high when diagnostic tissue samples are obtained. Obtaining specimens for research does not increase adverse event risk.
评估在当代实践中经皮肾上腺肿块活检的适应证、安全性和有效性。
本研究经机构审查委员会批准，回顾性分析了 2015 年 1 月 6 日至 2023 年 1 月 6 日期间在学术医疗系统中接受经皮影像引导肾上腺肿块活检的所有患者。记录患者的人口统计学数据、活检适应证、肿块大小、实验室数据、病理结果和并发症。最终诊断基于病理学或当活检标本未获得恶性组织时进行至少 1 年的影像学随访。检测性能计算排除了重复活检。连续变量采用学生 t 检验进行比较，二分类变量采用卡方检验进行比较。
共 160 例患者进行了 186 次活检。活检的适应证为诊断转移性疾病（139/186；74.7%）、仅用于肿瘤学研究（27/186；14.5%）、诊断转移性疾病和肿瘤学研究（15/186；8%）和诊断偶发肾上腺肿块（5/186；2.7%）。154 例（96.3%）患者的活检标本有诊断意义，6 例（3.8%）患者的活检标本无诊断意义。诊断性活检获得恶性组织（n=136）、良性肾上腺组织（n=12）和良性肾上腺肿瘤（n=6），敏感性为 98.6%（136/138），特异性为 100%（16/16），阳性预测值为 100%（136/136），阴性预测值为 88.9%（16/18）。186 例中有 11 例（5.9%）出现了不良事件，大多数为轻微不良事件（7/11；63.6%）。尽管为研究目的获取的标本更多（5.8 比 3.7；p<0.001），但获得组织用于临床或研究目的的不良事件发生率相似（144 例中有 10 例[6.9%]比 42 例中有 1 例[2.4%]；p=0.27）。
经皮肾上腺肿块活检是安全、准确的，几乎专门用于诊断转移性疾病或用于肿瘤学研究。获得诊断性组织样本时，阴性预测值较高。为研究目的获取标本不会增加不良事件风险。
