Percutaneous Adrenal Biopsy

With improved imaging and recent techniques, such as contrast medium washout measurement on CT and chemical-shift MRI, only a small proportion of adrenal masses cannot be characterized accurately and require percutaneous biopsy for diagnosis. However, before percutaneous biopsy, the possibility of a pheochromocytoma must be excluded because of the risk of an adrenal crisis induced by the biopsy. In a recent study by Harisinghani et al. [26], the NPV of adrenal biopsies was shown to be between 98% and 100%. In this study, 225 CT-guided biopsies were evaluated, where no malignant lesion was missed on the first biopsy. It was concluded that a single negative biopsy for malignancy can be regarded as a true negative, and there is no necessity to repeat the biopsy. Percutaneous CT-guided adrenal biopsy is a relatively safe procedure in patients with a known extra-adrenal malignancy. Minor complications of adrenal biopsy include abdominal pain, hematuria, nausea and small pneu-mothoraces. Major complications, generally regarded as those requiring treatment, occur in 2.8-3.6% of cases and include pneumothoraces requiring intervention, and hemorrhage. There are also isolated reports of adrenal abscesses, pancreatitis and seeding of metastases along the needle track [26].

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