title: EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer.
abstract: In patients with lung cancer, enlarged or (18)Fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) positive left adrenal glands are suspected for distant metastases and require tissue confirmation for a definitive assessment. The aim of this study was to assess the sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for left adrenal metastases in lung cancer patients with a suspect adrenal gland based on imaging. EUS-FNA findings of patients with (suspected) lung cancer and CT enlarged or (18)FDG-PET positive left adrenal glands were retrospectively evaluated. In the absence of metastases at EUS, clinical and radiological follow-up was obtained. In 85 patients, EUS-FNA demonstrated left adrenal metastases of lung cancer in 53 (62%), benign adrenal tissue in 25 (29%), a metastasis from colon carcinoma in 1 (1%) and a primary adrenocortical carcinoma in 1 (1%) patient. In five patients (5.9%), the aspirates contained non-representative material. EUS outcomes were false negative in two patients. Sensitivity and negative predictive value (NPV) for EUS-FNA of the left adrenal gland were at least 86% (95% CI 74-93%) and 70% (95% CI 50-85%). No complications occurred. EUS-FNA is a sensitive, safe and minimally invasive technique to provide tissue proof of left adrenal metastases in patients with (suspected) lung cancer and enlarged or (18)FDG-PET positive adrenal glands. Therefore, EUS-FNA qualifies as the staging test of choice for patients with lung cancer with suspected left adrenal metastases.
authors.affiliation: Department of Pulmonology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. o.schuurbiers@long.umcn.nl
authors.forename: Olga C J
authors.initials: OC
authors.lastname: Schuurbiers
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Tournoy
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schoppers
authors.forename: Bernadette G
authors.initials: BG
authors.lastname: Dijkman
authors.forename: Henri J L M
authors.initials: HJ
authors.lastname: Timmers
authors.forename: Lioe-Fee
authors.initials: LF
authors.lastname: de Geus-Oei
authors.forename: Johanna M M
authors.initials: JM
authors.lastname: Grefte
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
authors.forename: P N Richard
authors.initials: PN
authors.lastname: Dekhuijzen
authors.forename: Henricus F M
authors.initials: HF
authors.lastname: van der Heijden
authors.forename: Jouke T
authors.initials: JT
authors.lastname: Annema
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000556:secondary; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000503:physiopathology / Q000556:secondary; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography