Incidentaloma other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D [2]

Overview

Fine-needle aspiration biopsy may be helpful in the diagnosis of incidentaloma. It can distinguish between an adrenal tumor and a metastatic tumor. In a patient with a known primary malignancy, performing a diagnostic CT-guided FNA biopsy may be indicated. The FNA biopsy of a pheochromocytoma may result in hemorrhage and hypertensive crisis. So, excluding pheochromocytoma with biochemical testing is necessary before any procedure. Adrenal biopsy is generally not indicated due to its limited accuracy for differentiating between benign and malignant adrenal tumors and the risk of seeding of malignant cells.

Fine-needle aspiration biopsy may be helpful in the diagnosis of incidentaloma. It can distinguish between an adrenal tumor and a metastatic tumor.^[1]

In a patient with a known primary malignancy, performing a diagnostic CT-guided FNA biopsy may be indicated.

Cytology from a specimen obtained by fine-needle aspiration (FNA) biopsy can not distinguish a benign adrenal mass from the less common adrenal carcinoma.

FNA biopsy is not useful in the routine evaluation of incidentalomas in patients suspected to have small non-adrenal cancers.^[2]
The FNA biopsy of a pheochromocytoma may result in hemorrhage and hypertensive crisis. So, excluding pheochromocytoma with biochemical testing is necessary before any procedure.^[3]
The complications of FNAC include:^[4]
- Adrenal and liver hematoma
- Abdominal pain
- Hematuria
- Pancreatitis
- Pneumothorax
- Adrenal abscess
- Tumor recurrence along the needle track

Adrenal biopsy is generally not indicated due to its limited accuracy for differentiating between benign and malignant adrenal tumors. In addition, it may result in tumor seeding in case of adrenocortical carcinoma.^[5]
A rare indication of adrenal biopsy is the strong suspicion of adrenal metastasis and biopsy confirmation would influence the management plan; in this case, lab testing to rule out a pheochromocytoma should be done first to avoid precipitation of a hyperadrenergic crisis by biopsy.

↑ Mazzaglia PJ, Monchik JM (2009). “Limited value of adrenal biopsy in the evaluation of adrenal neoplasm: a decade of experience”. Arch Surg. 144 (5): 465–70. doi:10.1001/archsurg.2009.59. PMID 19451490.
↑ Kumar R, Dey P (2016). “Fine-needle aspiration cytology of non-neoplastic adrenal pathology”. Diagn Cytopathol. 44 (6): 472–6. doi:10.1002/dc.23467. PMID 26956774.
↑ Vanderveen KA, Thompson SM, Callstrom MR, Young WF, Grant CS, Farley DR; et al. (2009). “Biopsy of pheochromocytomas and paragangliomas: potential for disaster”. Surgery. 146 (6): 1158–66. doi:10.1016/j.surg.2009.09.013. PMID 19958944.
↑ Arellano RS, Harisinghani MG, Gervais DA, Hahn PF, Mueller PR (2003). “Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications”. Curr Probl Diagn Radiol. 32 (1): 3–10. doi:10.1067/cdr.2003.120002. PMID 12574782.
↑ Bancos I, Tamhane S, Shah M, Delivanis DA, Alahdab F, Arlt W; et al. (2016). “DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis”. Eur J Endocrinol. 175 (2): R65–80. doi:10.1530/EJE-16-0297. PMID 27257146.