Adrenal Gland Biopsy Procedure

Indications for Adrenal Biopsy

• The American College of Radiology recommends CT-guided percutaneous biopsy for patients with a history of malignancy and suspected metastatic disease to the adrenal gland, as well as for indeterminate adrenal masses that remain equivocal after non-invasive imaging techniques 1, 4
• The American Urological Association suggests that adrenal biopsy should not be performed routinely for the work-up of adrenal incidentalomas 3

Pre-Biopsy Evaluation

• The American College of Radiology advises excluding pheochromocytoma before any adrenal biopsy, with screening using plasma or 24-hour urinary metanephrines in all patients with adrenal masses or symptoms of catecholamine excess 1, 3, 5
• A complete hormonal evaluation, including cortisol secretion assessment and aldosterone-to-renin ratio, should be performed before considering biopsy 3, 5

Biopsy Technique

• The European Respiratory Society recommends EUS-guided FNA as an effective approach for left adrenal gland biopsies, with a sensitivity and negative predictive value of at least 86% and 70%, respectively 6, 7

Diagnostic Yield and Accuracy

• The American College of Radiology reports that adequate tissue samples are obtained in 81-96% of cases, with an accuracy for malignant lesions of 96-100% when sufficient material is obtained 1

Complications

• The American College of Radiology notes that complication rates range from 8-12%, with potential complications including bleeding, pneumothorax, infection, and tumor seeding along the needle track 1
• The American College of Radiology also warns of the risk of hypertensive crisis in undiagnosed pheochromocytomas 5

Special Considerations

• The European Respiratory Society suggests that dedicated adrenal imaging with CT or MRI should be performed before considering biopsy to avoid unnecessary procedures, and that EUS-FNA is a reasonable alternative to percutaneous approaches for left adrenal gland biopsies in patients with lung cancer 6, 7, 8