title: EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies.
abstract: BACKGROUND
  The diagnostic yield and safety of trans-gastric EUS-guided FNA of the left adrenal gland are not well defined.
  
  
  METHODS
  All patients with an enlarged left adrenal gland on abdominal imaging and known or suspected malignancy referred to two EUS centers over a 3-year period were included in this study. EUS-guided FNA was performed on an outpatient basis by one of 4 experienced endosonographers.
  
  
  RESULTS
  Thirty-one consecutive patients (21 men, 10 women; mean age 64.8 years) were evaluated. Tissue adequate for interpretation was obtained in all patients; no attempt to obtain tissue was unsuccessful. The median number of needle passes was 4.5 (range 1-8). No immediate complications were encountered. EUS-guided FNA confirmed malignant left adrenal involvement in 42% (13/31) of the patients. Patients with malignant left adrenal masses were more likely to have known cancer at another site (OR 12.0: 95% CI[1.6, 87.9]). Patients with benign masses were more likely to have preservation of the normal sonographic appearance of the adrenal gland ("seagull" configuration) compared with those with malignant masses (OR 9.8: 95% CI[1.9, 51.0]). The accuracy of EUS imaging based on size (> or =3 cm) alone was 81%: 95% CI[63, 93]). Of the patients with malignant adrenal masses, 85% (11/13) died or their clinical condition deteriorated during follow-up, while 15% (2/13) were being treated and were stable clinically.
  
  
  CONCLUSIONS
  EUS-guided FNA of the left adrenal gland is a minimally invasive, safe, and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or GI malignancies.
authors.affiliation: Department of Medicine, The Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Tamhane
authors.forename: Boris
authors.initials: B
authors.lastname: Brand
authors.forename: Victor K
authors.initials: VK
authors.lastname: Chen
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Salem
authors.initials: S
authors.lastname: Omar
authors.forename: Theodoros
authors.initials: T
authors.lastname: Topalidis
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology