EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies

Gastrointest Endosc. 2004 May;59(6):627-33. doi: 10.1016/s0016-5107(04)00296-2.


Background: The diagnostic yield and safety of trans-gastric EUS-guided FNA of the left adrenal gland are not well defined.

Methods: All patients with an enlarged left adrenal gland on abdominal imaging and known or suspected malignancy referred to two EUS centers over a 3-year period were included in this study. EUS-guided FNA was performed on an outpatient basis by one of 4 experienced endosonographers.

Results: Thirty-one consecutive patients (21 men, 10 women; mean age 64.8 years) were evaluated. Tissue adequate for interpretation was obtained in all patients; no attempt to obtain tissue was unsuccessful. The median number of needle passes was 4.5 (range 1-8). No immediate complications were encountered. EUS-guided FNA confirmed malignant left adrenal involvement in 42% (13/31) of the patients. Patients with malignant left adrenal masses were more likely to have known cancer at another site (OR 12.0: 95% CI[1.6, 87.9]). Patients with benign masses were more likely to have preservation of the normal sonographic appearance of the adrenal gland ("seagull" configuration) compared with those with malignant masses (OR 9.8: 95% CI[1.9, 51.0]). The accuracy of EUS imaging based on size (> or =3 cm) alone was 81%: 95% CI[63, 93]). Of the patients with malignant adrenal masses, 85% (11/13) died or their clinical condition deteriorated during follow-up, while 15% (2/13) were being treated and were stable clinically.

Conclusions: EUS-guided FNA of the left adrenal gland is a minimally invasive, safe, and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or GI malignancies.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / pathology*
  • Adrenal Gland Neoplasms / secondary*
  • Adrenal Glands / diagnostic imaging
  • Adrenal Glands / pathology*
  • Aged
  • Aged, 80 and over
  • Biopsy, Fine-Needle / methods*
  • Endosonography*
  • Esophageal Neoplasms / pathology
  • Female
  • Gastrointestinal Neoplasms / pathology*
  • Humans
  • Lung Neoplasms / pathology*
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / pathology