FINE-NEEDLE ASPIRATION BIOPSY OF ADRENAL MASSES IN PATIENTS WITH EXTRAADRENAL MALIGNANCY

Background. Reports evaluating the efficacy of fine needle aspiration (FNA) of the adrenal gland have suggested a possible correlation betwe en size Of an adrenal mass and the presence of a primary or metastatic malignancy. These studies have focused on FNAs of all adrenal gland m asses regardless of clinical history. This study investigates this rel ationship in a subpopulation of patients with a known history of prima ry extraadrenal malignancy. Methods. All patients who have undergone c omputed tomographic-guided FNA biopsy of an adrenal mass at Loyola Uni versity Medical Center and Hines Veterans Administration Hospital, fro m 1985 to 1991, were reviewed. Results. If size was assumed to be an i ndependent predictor for presence of metastases, the highest efficienc y was obtained with a cutoff value of 3 cm. This value divided the gro up into 15 (42%) ''low-risk '' (less-than-or-equal-to 3 cm) and 21 (58 %) ''high-risk '' (>3 cm) subjects. In the ''low-risk '' group, 8 7% o f the masses (13 of 15) were benign and 13% (2 of 15) were malignant. Within the ''high-risk'' group, more than 95% of the masses (20 of 21) were malignant, with a single (5%) benign case (P < 0.05). Conclusion s. There is a significant correlation between the size of an adrenal n odule and the presence of metastases in patients with a known primary extraadrenal malignancy. Nodules greater than 3 cm have a very high pr obability of involvement by metastatic tumor. Nodules 3 cm or smaller are usually benign, but metastatic tumor can still be found in up to 1 3%. FNA biopsy is useful in evaluating adrenal masses in this setting.