Cytological Assessment of Adrenal Tumours: Insights From 22-Years Single Centre Experience

Objective

The incidence of adrenal tumours has increased in the last decades, mainly due to increased use of imaging. The diagnostic evaluation of adrenal masses can be complex and, in some cases, necessitates cytological evaluation. However, concerns remain regarding the potential complications associated with adrenal gland biopsy.

Design

We conducted a retrospective cohort study to evaluate the safety and diagnostic effectiveness of cytology in patients who underwent fine-needle aspiration (FNA) of adrenal glands at Karolinska University Hospital in Stockholm, Sweden, between 2000 and 2022. The aim was to evaluate the accuracy of the sample and the complication rate.

Patients and Measurements

A total of 241 patients and 251 FNAs were included, with 10 patients undergoing two FNAs each. Data on clinical, radiological and laboratory presentation was collected and corelated with cytological findings and outcomes.

Results

Diagnostic FNA was obtained in 90% of patients (n = 217) with endoscopic ultrasound technique being most successful (95.8%), followed by CT (88.7%) and transabdominal ultrasound technique (86.7%). The sensitivity and the specificity were 93.8% respectively 96.7%. More than half of the FNA samples (52.7%) indicated a diagnosis consistent with metastases to the adrenal gland. The complication rate was 7.9% (n = 20). Based on the FNA results, adrenalectomy was performed on 13.6%, while 52.8% of the patients with benign findings were managed conservatively. Chemotherapy was started for 78.7% of patients with malignant findings.

Conclusion

FNA of the adrenal glands is a safe, minimally invasive diagnostic procedure that can be useful in the assessment of adrenal lesions.