Role of sonographically guided fine-needle aspiration biopsy of adrenal masses in patients with lung cancer.

Purpose: The aims of this retrospective study were to determine the accuracy and safety of sonographically guided fine-needle aspiration biopsy (FNAB) in evaluating enlarged adrenal glands in patients with lung cancer and to correlate the metastatic involvement of the adrenal glands with the surgical stage of the primary lung tumor.

Methods: During an 11-year period, 64 patients with cytologically proven lung cancer had undergone sonographically guided FNABs of an adrenal mass. The accuracy of this method was assessed on the basis of cytologic findings and the safety, on the number of complications reported after FNAB. The location of the adrenal metastasis relative to the primary tumor (ipsilateral, contralateral, or bilateral) was correlated with the surgical stage of the disease.

Results: FNAB results were accurate in 58 of the 64 cases (91%), and the procedure was associated with no serious complications. In 6 (9%) of the 64 patients, the FNAB specimen had been inadequate. Cytologic analysis of the aspirates revealed malignancy in 52 (90%) of the 58 patients in whom the FNAB specimen had been adequate for an accurate diagnosis. The adrenal metastases were ipsilateral in 21 patients, contralateral in 15, and bilateral in 16, for an ipsilateral-to-contralateral ratio of 1.4:1. Among patients with operable disease, an ipsilateral pattern of metastasis was present in 65%, whereas among those with inoperable disease, the ipsilateral pattern was present in only 31%. The difference between these 2 groups was statistically significant (p < 0.05).

Conclusions: Sonographically guided FNAB is accurate and safe for evaluating enlarged adrenal glands in patients with lung cancer. Our results also suggest that a solitary ipsilateral adrenal metastasis in a patient with resectable primary lung cancer may represent a regional extension of the disease rather than systemic spread.