EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study

• Published in: PloS one 2019-06
• Main Authors: Martín Cardona, Albert, Fernández Esparrach, Glòria, Subtil, J. C, Iglesias García, J, García Guix, Marta, Barturen Barroso, A, Gimeno García, A. Z, Esteban, J. M, Pardo Balteiro, A, Velasco Guardado, A, Vázquez Sequeiros, E, Loras, C, Martínez Moreno, B, Castellot, A, Huertas, C, Martínez Lapiedra, M, Sánchez Yagüe, A, Terán, A, Morales Alvarado, Víctor Jair, Betes, M, Iglesia, D. de la, Sánchez Montes, Cristina, Lozano, M. D, Lariño Noia, J, Ginés, A, Tebé, Cristian, Gornals Soler, Joan B, Spanish Group for EUS-Guided TA in the adrenal gland
• Format: Article
• Language: English
• Subjects: Cancer; Càncer; Diagnosis; Diagnòstic; Endoscopy; Endoscòpia
• ISSN: 1932-6203; 1932-6203

Background: There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. Methods: This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. Results: A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. Conclusions: EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.