EUS guided fine needle biopsy of the Adrenal gland- our experience at an Irish tertiary hospital

Aims Endoscopic ultrasound(EUS) guided Fine needle biopsy(FNB) of adrenal gland is a minimally invasive procedure used to obtain tissue samples from adrenal glands for diagnostic purposes. It is particularly useful in cases where adrenal masses are detected on imaging, and a pathological diagnosis is required to distinguish benign from malignant lesions. Our aim was to evaluate our centres experience with EUS guided FNB of the Adrenal Gland.

Methods We retrospectively reviewed our electronic data collection system in endoscopy (ENDORAAD) and all adrenal gland EUS-FNB cases performed in our centre till date were identified. Data regarding patient demographics, indication for procedure, size and site of lesion, type of needle used in obtaining sample, number of passes performed and histological outcome were all collected on each of the cases and then analysed.

Results Between May 2022 and September 2024, 12 adrenal gland EUS-FNB procedures were conducted. 10 were left adrenal and 2 were right adrenal cases; 7 patients were female with a median age of 68 years. All patients underwent EUS-FNB to assess for metastatic spread. The most common primary cancer at time of referral was non-small cell lung cancer (n=11) and our most commonly used needle was a 22g SharkCore needle (83% n=10). The mean number of passes with a needle was 2. Within our cohort 11 out of 12 cases yielded sufficient histological material for analysis, with 50% (n=6) confirming metastasis. Of the remaining 5 cases two were adrenal adenomas and three normal adrenal tissue (these patients had repeat imaging that showed no change in size of the gland or any evidence of ongoing metabolic or metastatic activity). Only one patient (8% of cohort) had biopsy samples that were negative for malignant spread however repeat imaging raised concern for ongoing metastatic activity thus the histology in this case was considered non diagnostic. There were no immediate or delayed complications noted in any of our cases.

Conclusions In our experience EUS-guided FNB is a precise, minimally invasive, and safe technique for diagnosing adrenal lesions, particularly in the left gland. It is a preferred alternative to invasive procedures, especially for complex cases, and remains vital in diagnosing adrenal masses.

Publication History

Article published online:
27 March 2025