New England Surgical Society (NESS)
Search NESS
  Annual Meeting
  Annual Resident and Fellow Research Day
      Member Directory
      Members Only
  Scholars Foundation
  Job Board
  Journal of the American College of Surgeons
  Contact NESS

2008 Annual Meeting Abstracts

Adrenal Biopsy is Unhelpful in the Evaluation of Adrenal Incidentaloma : A Decade of Experience
Peter J. Mazzaglia, M.D., Jack M. Monchik, M.D..
Rhode Island Hospital, Providence, RI, USA.

Objective: Examine the role for percutaneous adrenal biopsy.
Design: Retrospective review
Setting: Tertiary referral center
Patients: All adult patients undergoing image-guided adrenal biopsy from 1997 to 2007.
Main Outcome Measure: Biopsy accuracy
Results: There were 163 biopsies performed on 154 patients, 95 males and 59 females. Mean age was 66 ± 12.5 years. Eighty-eight biopsies (53.4%) were performed in patients with a prior diagnosis of cancer. Forty-five (26.4%) were performed when an imaging study suggested previously undiagnosed cancer with a simultaneous adrenal metastasis. Thirty (20.2%) were performed for isolated adrenal incidentalomas. Rates of positive biopsy in these three groups were 70.6%, 69.0%, and 16.7%, respectively. Pre-biopsy evaluation for pheochromocytoma was performed in < 5% of patients with established or suspected non-adrenal malignancies, and 32% of patients with incidentalomas. In patients with isolated adrenal incidentaloma, a radiology report recommended biopsy 33% of the time, for characteristics inconsistent with benign adenoma. Of the isolated incidentalomas, there were 21 benign, 3 adrenocortical carcinomas, 2 pheochromocytoma, 2 non-diagnostic, 1 lymphoma and 1 sarcoma. Benign incidentalomas measured 4.2 ± 2.1 cm (range 1.4-10.7), and malignancies measured 9.3 ± 3.3 cm (range 5.3-14) (p < .05). All incidentalomas ≤ 5 cm (n=18) were benign. There were 4 false negative biopsies: 3 adrenocortical carcinomas and 1 pheochromocytoma.
Conclusions: Biopsy is unhelpful in patients with isolated adrenal incidentaloma. Despite atypical radiographic findings, all non-functioning nodules ≤ 5 cm were benign. The negative predictive value is unacceptably low, and cannot be relied upon to rule out malignancy. Biopsy’s value remains the diagnosis of metastatic carcinoma in patients with a non-adrenal primary, proven by the > 70% positive rate in this group.


Copyright © 2020 New England Surgical Society. All Rights Reserved.
Read Privacy Policy.