title: DIAGNOSIS OF ENDOCRINE DISEASE: The diagnostic performance of adrenal biopsy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review of published literature on adrenal biopsy and to assess its performance in diagnosing adrenal malignancy.
  
  
  METHODS
  Medline In-Process and Other Non-Indexed Citations, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trial were searched from inception to February 2016. Reviewers extracted data and assessed methodological quality in duplicate.
  
  
  RESULTS
  We included 32 observational studies reporting on 2174 patients (39.4% women, mean age 59.8 years) undergoing 2190 adrenal mass biopsy procedures. Pathology was described in 1621/2190 adrenal lesions (689 metastases, 68 adrenocortical carcinomas, 64 other malignancies, 464 adenomas, 226 other benign, 36 pheochromocytomas, and 74 others). The pooled non-diagnostic rate (30 studies, 2013 adrenal biopsies) was 8.7% (95%CI: 6-11%). The pooled complication rate (25 studies, 1339 biopsies) was 2.5% (95%CI: 1.5-3.4%). Studies were at a moderate risk for bias. Most limitations related to patient selection, assessment of outcome, and adequacy of follow-up. Only eight studies (240 patients) could be included in the diagnostic performance analysis with a sensitivity and specificity of 87 and 100% for malignancy, 70 and 98% for adrenocortical carcinoma, and 87 and 96% for metastasis respectively.
  
  
  CONCLUSIONS
  Evidence based on small sample size and moderate risk of bias suggests that adrenal biopsy appears to be most useful in the diagnosis of adrenal metastasis in patients with a history of extra-adrenal malignancy. Adrenal biopsy should only be performed if the expected findings are likely to alter the management of the individual patient and after biochemical exclusion of catecholamine-producing tumors to help prevent potentially life-threatening complications.
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA Bancos.Irina@mayo.edu.
authors.forename: Irina
authors.initials: I
authors.lastname: Bancos
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Shrikant
authors.initials: S
authors.lastname: Tamhane
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Shah
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism, and Nutrition, and Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Danae A
authors.initials: DA
authors.lastname: Delivanis
authors.affiliation: Evidence-Based Practice CenterCenter for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.affiliation: Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK and Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Arlt
authors.affiliation: Department of Internal MedicineDivision of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.affiliation: Evidence-Based Practice CenterCenter for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000307:Adrenal Gland Diseases / Q000175:diagnosis* / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000473:pathology; D000311:Adrenal Glands / Q000473:pathology*; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis* / Q000473:pathology