Transcutaneous biopsy of adrenocortical carcinoma is rarely helpful in diagnosis, potentially harmful, but does not affect patient outcome.
BACKGROUND
Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The utility, sensitivity, and effect on patient outcome of transcutaneous adrenal biopsy (TAB) for single, large, adrenal masses are unclear.


OBJECTIVE
This study evaluated the utility, diagnostic sensitivity, and effect on patient outcome of TAB in patients with ACC.


METHODS
We conducted a retrospective review of the electronic medical records of all ACC patients who were evaluated at the University of Michigan Health System from 1991 to 2011. We evaluated the sensitivity of TAB for tumors with the final pathological diagnosis of ACC. We compared the characteristics and survival of patients with stage I-III disease who underwent TAB with those who did not undergo TAB.


RESULTS
A total of 75 ACC patients with TAB were identified. Complications occurred in at least 11% of patients and were mainly associated with bleeding. The maximum sensitivity of the procedure in diagnosing ACC was 70%. For stage I-III patients, baseline characteristics, stage at diagnosis, and adjuvant treatment with mitotane or radiation were not significantly different between the TAB (n=36) and the non-TAB (n=254) groups. There was no significant difference in recurrence-free (P=0.7) or overall survival (P=0.7) between patients who underwent TAB and those who did not.


CONCLUSIONS
TAB of single, large, adrenal masses is usually unnecessary, exposes patients to risk, but does not affect recurrence-free or overall survival.
University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA.
Andrew R
AR
Williams
University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA.
Gary D
GD
Hammer
University of Michigan Medical School1301 Catherine Street, Ann Arbor, Michigan 48109, USADivision of MetabolismEndocrinology and Diabetes (MEND), Department of Internal Medicine, University of Michigan Hospital and Health Systems, NI3 A17, 300 North Ingalls, Ann Arbor, Michigan 48109-5419, USA telse@umich.edu.
Tobias
T
Else
D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D018268:Adrenocortical Carcinoma / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008939:Mitotane / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D008939:Mitotane