Use and Usefulness of Adrenal Core Biopsies Without FNA or On-site Evaluation of Adequacy A Study of 204 Cases for a 12-Year Period

Department of Pathology, The Ohio State University Medical Center, Columbus, OH 43210, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 01/2012; 137(1):124-31. DOI: 10.1309/AJCP4JE4FVDJFLIJ
Source: PubMed


While several studies have assessed the efficacy of adrenal fine-needle aspiration, there are few data regarding adrenal tissue core biopsies. We performed a retrospective study, for a 12-year period, of 204 percutaneous adrenal core biopsy specimens. A core was the only specimen obtained, and on-site evaluation was not used. About half of the cases (104/204) were diagnosed as metastatic carcinoma, with lung as the most common origin (78/204). A specificity and sensitivity of 100% for benign vs malignant was calculated, with a specificity of 88% and sensitivity of 86% for specific diagnoses. Diagnostic and sampling errors were identified. False-negatives were limited to biopsies using 20-gauge needles. Cases with a clinical history provided had specific diagnoses made at a slightly higher frequency compared with cases without an available history. Immunohistochemical workup was performed in more than half of the cases; specific diagnoses were made more frequently than in cases without immunostains.

Download full-text


Available from: Debra Zynger, Sep 11, 2015
3 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and purpose: Positron-emission tomography/computed tomography (PET/CT) with fluorine-18 fluorodeoxyglucose (FDG) is used as first-line staging for patients with newly diagnosed non-small cell lung cancer (NSCLC). Our purpose was to review the accuracy of FDG-PET/CT to predict adrenal gland metastasis, explain the causes for false-positive PET, and provide a diagnostic algorithm. Patients and methods: Two patients with incidentally discovered lung masses were found to have hypermetabolic adrenal activity by FDG-PET/CT with maximal standard uptake value (SUV) of 4.5 and 6.5. A MEDLINE search was performed on the topic of FDG-PET/CT, adrenal gland metastasis, and NSCLC. Literature was reviewed with regard to diagnosis, accuracy, outcomes, and alternative imaging or diagnostic strategies. Results: Both patients underwent transabdominal laparoscopic adrenalectomy and were found to have nodular hyperplasia without evidence of adrenal tumor. A total of seven articles containing 343 patients were identified as having pertinent oncologic information for NSCLC patients with adrenal lesions. Sensitivity and specificity of PET/CT for distant metastasis was 94% and 85%, respectively, but only 13% (44/343) of these patients had histologically confirmed adrenal diagnoses. Based on this, a diagnostic algorithm was created to aid in decision making. Conclusions: Although PET/CT has high sensitivity and specificity for adrenal metastasis in the setting of NSCLC, adrenal biopsy or other secondary imaging should be considered to confirm the finding. Adrenalectomy in lieu of biopsy may have both diagnostic and therapeutic benefit in cases where the adrenal mass is ≥10 mm with high PET maximum SUV (≥3.1) and SUV ratios (>2.5), where washout CT or chemical shift MRI is positive, or where percutaneous biopsy is deemed too difficult or unsafe.
    Journal of endourology / Endourological Society 08/2013; 28(1). DOI:10.1089/end.2013.0380 · 1.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The evolving nature of medicine has created new challenges in numerous aspects of the practice of pathology. The development of less invasive procedures, the generation of better diagnostic tools, and the recognition of prognostic markers have contributed to these challenges. Between 42.7% and 65.0% of intraoperative consultations are performed to identify or type a neoplastic process. We instituted a reporting requirement on our intraoperative consultations to provide an assessment of adequacy. The assessment of adequacy was subjective by its very nature and was based on the possible uses for the submitted tissue. A total of 3086 intraoperative consultations were performed over a 13-month period. Sixty-two cases were determined to be insufficient for ancillary studies; 52 of these cases were remedied by the surgeon during the original diagnostic procedure. We have instituted a new assessment for intraoperative consultations to optimize the tissue obtained and reduce the need for additional procedures.
    International Journal of Surgical Pathology 09/2013; 21(6). DOI:10.1177/1066896913502224 · 0.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Evaluation for malignancy of the adrenal cortex, adrenal cortical carcinoma (ACC), is a challenge in surgical pathology due to its relative rarity and histologic overlap with its benign counterpart, adrenocortical adenoma (ACA). We characterized a cohort of human ACC and ACA, including a molecular screen, with a goal of identifying potential diagnostic adjuncts. Thirty-six cases of ACC underwent histologic and clinical review. In the 31 ACC cases with available material and a cohort of 10 ACA cases, a multiplex nucleotide amplification molecular screen from formalin-fixed, paraffinembedded tissue was peformed. ACCs demonstrated a wide variety of clinical and histologic characteristics with overall poor but unpredictable survival for subjects with ACC. By mutational screen, 12/31 (38.7%) carcinomas harbored CTNNB1 mutations, 1 with an additional TP53 mutation; 1 case each had isolated APC and TP53 mutations; 16 were wild-type for all tested loci; and 1 case demonstrated repeated assay failures. Two of the 10 ACA (20%) demonstrated CTNNB1 mutations by mutational screen, with no additional mutations. Immunohistochemistry for beta-catenin was performed and compared with the results of the molecular screen. Strong nuclear beta-catenin immunopositivity corresponded to the presence of CTNNB1 mutation by genotyping in 10 of 12 cases (83% sensitivity); the mismatched case(s) demonstrated strong membranous staining by immunohistochemistry. Seventeen of the 18 cases without CTNNB1 mutation showed membranous staining or did not stain (94% specificity); the mismatched case demonstrated scattered (<10%) positive nuclei. Both mutations in ACA were corroborated with immunohistochemistry for betacatenin. No histomorphologic parameter appeared dominant in lesions with a particular mutational status. Based on these results, mutational status of CTNNB1 in adrenal cortical neoplasms can be predicted with reasonable accuracy by immunohistochemical cellular localization. Nuclear localization of beta-catenin by immunostain may be helpful in analysis of select lesions of the adrenal cortex whose biological behavior is uncertain from clinical and histologic information; a larger cohort is required to test this hypothesis.
    03/2015; 3. DOI:10.15190/d.2015.32
Show more