Incidentaloma other diagnostic studies: Difference between revisions
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==Overview== | ==Overview== | ||
[ | [[Needle aspiration biopsy|Fine-needle aspiration biopsy]] may be helpful in the diagnosis of incidentaloma. It can distinguish between an [[Adrenal gland|adrena]]<nowiki/>l tumor and a [[Metastasis|metastatic]] tumor. In a patient with a known primary [[malignancy]], performing a diagnostic [[Computed tomography|CT]]-guided [[Needle aspiration biopsy|FNA]] biopsy may be indicated. The [[Needle aspiration biopsy|FNA]] biopsy of a [[pheochromocytoma]] may result in [[hemorrhage]] and [[hypertensive crisis]]. So, excluding [[pheochromocytoma]] with biochemical testing is necessary before any procedure. [[Adrenal gland|Adrenal]] [[biopsy]] is generally not indicated due to its limited accuracy for differentiating between [[benign]] and [[malignant]] [[Adrenal gland|adrenal]] [[tumors]] and the risk of [[seeding]] of [[malignant]] cells. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
*Fine-needle aspiration biopsy may be helpful in the diagnosis of incidentaloma. | *[[Needle aspiration biopsy|Fine-needle aspiration biopsy]] may be helpful in the diagnosis of incidentaloma. It can distinguish between an [[Adrenal gland|adrena]]<nowiki/>l tumor and a [[Metastasis|metastatic]] tumor.<ref name="pmid19451490">{{cite journal| author=Mazzaglia PJ, Monchik JM| title=Limited value of adrenal biopsy in the evaluation of adrenal neoplasm: a decade of experience. | journal=Arch Surg | year= 2009 | volume= 144 | issue= 5 | pages= 465-70 | pmid=19451490 | doi=10.1001/archsurg.2009.59 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19451490 }}</ref> | ||
* In a patient with a known primary malignancy, performing a diagnostic CT-guided FNA biopsy may be indicated. | *In a patient with a known primary [[malignancy]], performing a diagnostic [[Computed tomography|CT]]-guided [[Needle aspiration biopsy|FNA]] biopsy may be indicated. | ||
* Cytology from a specimen obtained by fine-needle aspiration (FNA) | *[[Cytology]] from a specimen obtained by [[fine-needle aspiration]] ([[Needle aspiration biopsy|FNA]]) biopsy can not distinguish a [[benign]] [[Adrenal gland|adrenal]] [[mass]] from the less common [[Adrenal gland|adrenal]] [[carcinoma]]. | ||
* FNA biopsy is not useful in the routine evaluation of incidentalomas in patients suspected to have small non-adrenal cancers.<ref name="pmid26956774">{{cite journal| author=Kumar R, Dey P| title=Fine-needle aspiration cytology of non-neoplastic adrenal pathology. | journal=Diagn Cytopathol | year= 2016 | volume= 44 | issue= 6 | pages= 472-6 | pmid=26956774 | doi=10.1002/dc.23467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26956774 }}</ref> | *[[Needle aspiration biopsy|FNA]] biopsy is not useful in the routine evaluation of incidentalomas in patients suspected to have small non-adrenal cancers.<ref name="pmid26956774">{{cite journal| author=Kumar R, Dey P| title=Fine-needle aspiration cytology of non-neoplastic adrenal pathology. | journal=Diagn Cytopathol | year= 2016 | volume= 44 | issue= 6 | pages= 472-6 | pmid=26956774 | doi=10.1002/dc.23467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26956774 }}</ref> | ||
*The [[Needle aspiration biopsy|FNA]] biopsy of a [[pheochromocytoma]] may result in [[hemorrhage]] and [[hypertensive crisis]]. So, excluding [[pheochromocytoma]] with biochemical testing is necessary before any procedure.<ref name="pmid19958944">{{cite journal| author=Vanderveen KA, Thompson SM, Callstrom MR, Young WF, Grant CS, Farley DR et al.| title=Biopsy of pheochromocytomas and paragangliomas: potential for disaster. | journal=Surgery | year= 2009 | volume= 146 | issue= 6 | pages= 1158-66 | pmid=19958944 | doi=10.1016/j.surg.2009.09.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19958944 }}</ref> | |||
*The complications of [[FNAC]] include:<ref name="pmid12574782">{{cite journal| author=Arellano RS, Harisinghani MG, Gervais DA, Hahn PF, Mueller PR| title=Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications. | journal=Curr Probl Diagn Radiol | year= 2003 | volume= 32 | issue= 1 | pages= 3-10 | pmid=12574782 | doi=10.1067/cdr.2003.120002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12574782 }}</ref> | |||
**Adrenal and [[liver]] [[hematoma]] | |||
**[[Abdominal pain|Abdominal pain]] | |||
**[[Hematuria|Hematuria]] | |||
**[[Pancreatitis]] | |||
**[[Pneumothorax]] | |||
**[[Adrenal gland|Adrenal]] [[abscess]] | |||
**[[Tumor]] recurrence along the needle track | |||
* | * [[Adrenal gland|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]].<ref name="pmid27257146">{{cite journal| author=Bancos I, Tamhane S, Shah M, Delivanis DA, Alahdab F, Arlt W | display-authors=etal| title=DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis. | journal=Eur J Endocrinol | year= 2016 | volume= 175 | issue= 2 | pages= R65-80 | pmid=27257146 | doi=10.1530/EJE-16-0297 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27257146 }}</ref> | ||
* A rare indication of [[Adrenal gland|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]]. | |||
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==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 02:39, 10 May 2021
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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.
Other Diagnostic Studies
- 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.
References
- ↑ 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.