Adrenal Mass Fine Needle Aspriations and Their Radiologic and Clinical Correlation
Tiffany A Thurow, Lin Liu. NorthShore University HealthSystem, Evanston, IL; University of Chicago Pritzker School of Medicine, Chicago, IL
Background: The increasing use of imaging techniques has contributed a great deal to the detection of adrenal gland lesions that may be as small as 1 cm. The most common indication for adrenal gland fine needle aspiration (FNA) biopsy is to detect a metastatic lesion for staging a malignancy. Primary adrenal gland neoplasms are very infrequent and many of them are incidental findings. The radiologic/clinical correlation with the FNA interpretation is especially important since only a small percentage of adrenal masses are resected.
Design: Thirty-one cases of adrenal gland FNAs were retrieved from NorthShore University HealthSystem pathology database from 2001 to 2011. The radiologic reports and clinical follow-up were obtained from the patients' electronic medical records. The correlation between all three parameters was analyzed.
Results: Of the 31 cases evaluated, 16 were women and 15 were men, with ages ranging from 48 to 87 years (mean 54 years). The sizes of the adrenal masses ranged from 1.2 cm to 8.0 cm. 71% (22 cases) were detected as part of the work-up of metastatic disease, while the remaining 9 lesions (29%) were found incidentally. The incidental lesions ranged in size from 2.0 to 8.0 cm, with a mean of 3.7cm.
Of all 31 cases, 18 (58%) showed satisfactory concordance between the cytology findings and the radiologic impression, while 10 (32%) were discordant, and 3 had imaging done at an outside hospital. Of the 10 discordant cases, all were suspected to be metastatic disease radiologically, based on masses detected elsewhere and/or positron emission tomography (PET) status. Each of the cases was found to be a benign lesion upon FNA. 9 (90%) of the discordant cases were adrenal masses less than 3.0 cm in size.
In this study cohort, only four cases had subsequent resection specimens. All of the surgical resctions correlated with the original FNA interpretation, with 2 cases as primary adrenal neoplasm (3.0 cm and 4.5 cm) and 2 cases as metastatic carcinoma.
Conclusions: Adrenal gland FNA is mainly reserved for masses suspected to represent metastasis. Radiologic and FNA discordance is fairly frequent (32%) and most common with lesions less than 3.0 cm. Therefore, FNAs of adrenal masses should be used in a more selective fashion, especially when measuring less than 3.0 cm.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 262, Monday Afternoon