EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study.

There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy.

This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy.

A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape.

EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.

PloS one. 2019 Jun 06*** epublish ***

A Martin-Cardona, G Fernandez-Esparrach, J C Subtil, J Iglesias-Garcia, M Garcia-Guix, A Barturen Barroso, A Z Gimeno-Garcia, J M Esteban, A Pardo Balteiro, A Velasco-Guardado, E Vazquez-Sequeiros, C Loras, B Martinez-Moreno, A Castellot, C Huertas, M Martinez-Lapiedra, A Sanchez-Yague, A Teran, V J Morales-Alvarado, M Betes, D de la Iglesia, C Sánchez-Montes, M D Lozano, J Lariño-Noia, A Gines, C Tebe, J B Gornals, On belhaf of Spanish Group for EUS-Guided TA in the adrenal gland

Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain., Endoscopy Unit, ICMDiM, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain., Endoscopy Unit, University of Navarra Clinic, Pamplona, Spain., Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain., Department of Digestive Diseases, Hospital Universitario Cruces, Bilbao, Spain., Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Tenerife, Spain., Endoscopy Unit, Department of Digestive Diseases, Hospital Clínico San Carlos, Madrid, Spain., Department of Digestive Diseases, Hospital Universitario Joan XXIII, Tarragona, Spain., Department of Digestive Diseases, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain., Endoscopy unit, Gastroenterology and Hepatology Service, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain., Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain., Department of Digestive Diseases, Hospital General Universitario de Alicante, Alicante, Spain., Department of Digestive Diseases, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain., Department of Digestive Diseases, Hospital Dr. Josep Trueta Girona, Girona, Spain., Instituto Oncológico Valenciano, Valencia, Spain., Endoscopy Unit, Hospital Costa Sol, Marbella, Spain., Department of Digestive Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Biostatistics Unit, Institute of Biomedical Research of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.