Percutaneous Adrenal Biopsies in Patients with Cancer: The Utility of Preprocedural Endocrine Workup

To assess the safety of adrenal biopsies in patients with known or suspected malignancies without preprocedural endocrine evaluations.

This was a single-center retrospective study that included 426 patients (249 men and 177 women; mean age, 66.1 years [SD ± 11.0]) with known or suspected malignancy who underwent 487 computed tomography (CT)-guided adrenal biopsies between October 2011 and December 2023. The authors analyzed medical records and cross-sectional imaging, evaluating technical and diagnostic success rates as well as complications.

Of the 487 biopsies, 442 (91%) were performed in patients with confirmed malignancies, whereas 45 cases (9%) were patients presenting with new abdominal or lung mass and adrenal mass. The most common primary malignancy was lung cancer (272 of 487, 56%). Technical success rate was 99.8% (486 of 487), with a diagnostic success rate of 97.1% (473 of 487). Histopathological findings differed from known primary malignancy in 2.9% (14 of 487) of cases. Endocrine assessments were performed before 40 biopsies (8.2%). Three (3 of 487, 0.61%) new histological diagnoses of pheochromocytoma emerged, with 2 (66%) occurring in patients with known malignancies. A total of 45 adverse events (9.2%) were observed, primarily Grades 1-2, with only 6 classified as Grade 3 (4 hemorrhages and 2 cases of hypertension). Only 1 case of Grade 3 hypertension linked to pheochromocytoma.

Incidence of pheochromocytoma in patients with known or suspected extra-adrenal malignancies without endocrine workup was less than 1%. Therefore, endocrine workup prior to adrenal biopsies in patients with known and suspected malignancies may not be indicated despite recommendations of international guidelines.