Biopsy of pheochromocytomas and paragangliomas: potential for disaster.
BACKGROUND
Pheochromocytomas and paragangliomas are highly vascular neuroendocrine neoplasms that often secrete catecholamines. Percutaneous biopsy has been associated with life-threatening hemorrhage, hypertensive crisis, capsular disruption with tumor implantation, and death. We sought to determine the outcomes of biopsy in 20 consecutive patients.


METHODS
We reviewed retrospectively the medical records of patients with biopsied pheochromocytomas and paragangliomas referred to our Endocrine Division for subsequent management between 1995 and 2005. Biopsy complications, operative findings, and outcomes were reviewed.


RESULTS
Twenty patients (14 pheochromocytomas and 6 paragangliomas) were biopsied percutaneously prior to referral. Mean tumor diameter was 6.4 cm (range, 1-15). Pre-biopsy biochemical testing was not performed in 90% of patients, and was negative in the remainder. Fourteen patients (70%) developed a biopsy-related complication, including: increased difficulty of the definitive operation in 7 of 17 (41%) operative cases with 1 patient requiring conversion to an open procedure; severe hypertension (15%); hematoma (30%); incorrect or inadequate biopsy (25%); severe pain (25%); and delay in surgical treatment (15%). Mean follow-up was 58 months, with 4 tumor-related deaths and 2 recurrences.


CONCLUSIONS
Biochemical testing prior to biopsy of adrenal or suspicious retroperitoneal masses is critical to exclude a catecholamine-secreting neoplasm because serious complications and increased operative difficulty can result.
Vanderveen
Kimberly A
KA
Department of Surgery, Mayo Medical School, Rochester, MN, USA.
Thompson
Scott M
SM
Callstrom
Matthew R
MR
Young
William F
WF
Grant
Clive S
CS
Farley
David R
DR
Richards
Melanie L
ML
Thompson
Geoffrey B
GB
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects*; D003951:Diagnostic Errors; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010235:Paraganglioma / Q000175:diagnosis*; D010673:Pheochromocytoma / Q000175:diagnosis*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies