The role of percutaneous CT-guided biopsy of an adrenal lesion in patients with known or suspected lung cancer
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INTERVENTIONAL RADIOLOGY
The role of percutaneous CT‑guided biopsy of an adrenal lesion in patients with known or suspected lung cancer E. McDermott1 · A. Kilcoyne2 · A. O’Shea2 · A. M. Cahalane2 · S. McDermott2 Received: 24 June 2020 / Revised: 26 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine the sensitivity, specificity, and complication rate of percutaneous adrenal biopsy in patients with known or suspected lung cancer. Methods This study was approved by the Institutional Review Board at our institution as a retrospective analysis; therefore, the need for informed consent was waived. All percutaneous adrenal biopsies performed between April 1993 and May 2019 were reviewed. 357 of 582 biopsies were performed on 343 patients with known or suspected lung cancer (M:F 164:179; mean age 66 years). The biopsy results were classified into malignant, benign, or non-diagnostic. The final diagnosis was established by pathology (biopsy and/or surgical resection) or imaging follow-up on CT for at least 12 months following the biopsy. Patients with less than 12 months follow-up were excluded (n = 44). Complications were recorded. Results The final diagnosis was metastatic lung cancer in 235 cases (77.8%), metastasis from an extrapulmonary primary in 2 cases (0.7%), pheochromocytoma in 2 cases (0.7%), and benign lesions in 63 cases (20.9%). Percutaneous adrenal gland biopsy had a sensitivity of 97% and specificity of 100% for lung cancer metastases. The non-diagnostic rate was 0.6%. Larger lesions were more likely to be malignant (p = 0.0000) and to be correctly classified as a lung metastasis (p = 0.025). The incidence of minor complications was 1.1%. There were no major complications. Conclusion Over 20% of adrenal lesions in patients with known or suspected lung cancer were not related to lung cancer. Percutaneous adrenal gland biopsy is a safe procedure, with high sensitivity and specificity for lung cancer metastases. Keywords Adrenal · Biopsy · Lung cancer · Computed tomography
Introduction Adrenal lesions are frequently encountered in patients with lung cancer, with a reported incidence of 4–18% [1–3]. Although the adrenal glands are a common site for lung cancer metastases [4, 5], up to 50% of adrenal lesions in patients with extra-adrenal malignancy are still likely to be benign [6–8]. The presence of metastatic disease has a significant impact on the prognosis and treatment of lung cancer patients. It is therefore important to differentiate between E. McDermott and A. Kilcoyne have contributed equally to this work and are first co-authors. * A. Kilcoyne [email protected] 1
Tallaght University Hospital, Tallaght, Dublin, Ireland
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
2
benign and malignant adrenal lesions in lung cancer patients to direct an optimal management plan. Noninvasive imaging techniques, such as non-contrast CT [9] and chemi
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