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. 2019 May-Jun;8(3):180-187.
doi: 10.4103/eus.eus_42_18.

Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis

Suhag Patel  1 , Raxitkumar Jinjuvadia  2 , Anupama Devara  3 , Paul H Naylor  4 , Mohammad Anees  5 , Kartikkumar Jinjuvadia  4 , Mohammad Al-Haddad  6
Affiliations

Performance characteristics of EUS-FNA biopsy for adrenal lesions: A meta-analysis

Suhag Patel et al. Endosc Ultrasound. 2019 May-Jun.

Abstract

Background and objective: The role of EUS-FNA biopsy (EUS-FNAB) for detection of metastatic lesions (mets) to adrenals has not been evaluated systematically. Our aim is to systematically evaluate the performance characteristics of EUS-FNAB in detecting metastasis to the adrenal glands.

Materials and methods: We performed a systematic search on PubMed and OvidSP from January 1990 to July 2016 using various search terms for EUS and adrenal lesion. Only articles published in English literature were included in the study. Studies with fewer than 10 patients were excluded from the study. Publication bias was assessed using Begg-Mazumdar test and visual inspection of funnel plots.

Results: Eight studies including 360 adrenal lesions that underwent EUS-FNAB were identified. Of these, 137 FNABs were conclusive for malignancy. Sensitivity of EUS-FNAB in detecting metastasis to the adrenals was 95% (95% confidence interval [CI]: 90%-98%) and specificity was 99% (95% CI: 96%-100%). Pooled positivity of EUS-FNAB in detecting lung cancer metastasis to the adrenals was 44% (95% CI: 31.5%-57.3%). No evidence of publication bias was noted.

Conclusion: Our study demonstrates that EUS-FNAB is highly sensitive and specific in detecting metastasis to adrenals. It also shows that up to about half of the patients with lung cancer and adrenal lesions on imaging have metastasis, a finding with profound implications on lung cancer staging and treatment.

Keywords: Adrenal mass; EUS-FNA biopsy; adrenal metastases in lung cancer.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Study selection chart
Figure 2
Figure 2
Quality of eligible studies as assessed by the QUADAS-2 criteria
Figure 3
Figure 3
Forest plot of studies reporting outcomes of EUS-FNAB in detecting metastases to adrenals: Pooled sensitivity
Figure 4
Figure 4
Forest plot of studies reporting outcomes of EUS-FNAB in detecting metastases to adrenals: Pooled specificity
Figure 5
Figure 5
Receiver operating characteristic curve
Figure 6
Figure 6
Pooled technical success rate in obtaining diagnostic sample
Figure 7
Figure 7
Pooled positivity in detecting lung cancer metastases to adrenals
See this image and copyright information in PMC

References

    1. Martinez M, LeBlanc J, Al-Haddad M, et al. Role of endoscopic ultrasound fine-needle aspiration evaluating adrenal gland enlargement or mass. World J Nephrol. 2014;3:92–100. - PMC - PubMed
    1. Grumbach MM, Biller BM, Braunstein GD, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”) Ann Intern Med. 2003;138:424–9. - PubMed
    1. Chapman GS, Kumar D, Redmond J, 3rd, et al. Upper abdominal computerized tomography scanning in staging non-small cell lung carcinoma. Cancer. 1984;54:1541–3. - PubMed
    1. Bodtger U, Vilmann P, Clementsen P, et al. Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer. J Thorac Oncol. 2009;4:1485–9. - PubMed
    1. Silvestri GA, Tanoue LT, Margolis ML, et al. The noninvasive staging of non-small cell lung cancer: The guidelines. Chest. 2003;123:147S–56S. - PubMed