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Clinical indications, safety, and effectiveness of percutaneous image-guided adrenal mass biopsy: an 8-year retrospective analysis in 160 patients

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess indications, safety, and effectiveness of percutaneous adrenal mass biopsy in contemporary practice.

Methods

This institutional review board-approved, retrospective study included all patients undergoing percutaneous image-guided adrenal mass biopsies at an academic health system from January 6, 2015, to January 6, 2023. Patient demographics, biopsy indications, mass size, laboratory data, pathology results, and complications were recorded. Final diagnoses were based on pathology or ≥ 1 year of imaging follow-up when biopsy specimens did not yield malignant tissue. Test performance calculations excluded repeat biopsies. Continuous variables were compared with Student’s t test, dichotomous variables with chi-squared test.

Results

A total of 160 patients underwent 186 biopsies. Biopsies were indicated to diagnose metastatic disease (139/186; 74.7%), for oncologic research only (27/186; 14.5%), diagnose metastatic disease and oncologic research (15/186; 8%), and diagnose an incidental adrenal mass (5/186; 2.7%). Biopsy specimens were diagnostic in 154 patients (96.3%) and non-diagnostic in 6 (3.8%). Diagnostic biopsies yielded malignant tissue (n = 136), benign adrenal tissue (n = 12), and benign adrenal neoplasms (n = 6) with sensitivity = 98.6% (136/138), specificity = 100% (16/16), positive predictive value = 100% (136/136), and negative predictive value = 88.9% (16/18). Adverse events followed 11/186 procedures (5.9%) and most minor (7/11, 63.6%). The adverse event rate was similar whether tissue was obtained for clinical or research purposes (10/144; 6.9% vs. 1/42; 2.4%, p = 0.27), despite more specimens obtained for research (5.8 vs. 3.7, p < 0.001).

Conclusion

Percutaneous adrenal mass biopsy is safe, accurate, and utilized almost exclusively to diagnose metastatic disease or for oncologic research. The negative predictive value is high when diagnostic tissue samples are obtained. Obtaining specimens for research does not increase adverse event risk.

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Acknowledgements

The authors wish to thank Laura E. Peterson for manuscript editing assistance.

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Matthew P. Schenker, Stuart G. Silverman, William W. Mayo-Smith, Ramin Khorasani & Daniel I. Glazer

  2. Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA, 02120, USA

    Ramin Khorasani & Daniel I. Glazer

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  1. Matthew P. Schenker
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All authors contributed to the conception/design of the work, participated in drafting and editing the manuscript, approved the final version, and are accountable for the manuscript contents.

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Correspondence to Daniel I. Glazer.

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Ethical approval

This Health Insurance Portability and Accountability Act-compliant study received Institutional Review Board approval. None relevant to the current study. Dr. Glazer reports educational/travel support from Siemens Healthineers as well as compensation for expert testimony regarding abdominal radiology cases.

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Schenker, M.P., Silverman, S.G., Mayo-Smith, W.W. et al. Clinical indications, safety, and effectiveness of percutaneous image-guided adrenal mass biopsy: an 8-year retrospective analysis in 160 patients. Abdom Radiol 49, 1231–1240 (2024). https://doi.org/10.1007/s00261-024-04211-0

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