Elsevier

Gastrointestinal Endoscopy

Volume 44, Issue 5, November 1996, Pages 568-572
Gastrointestinal Endoscopy

Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration of the left adrenal gland,☆☆,

https://doi.org/10.1016/S0016-5107(96)70010-XGet rights and content

Abstract

Background: We reported the application of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (FNA) in the local staging of lung cancer. Up to 16% of patients with lung cancer may have adrenal masses. The role of EUS in the characterization of the adrenal gland, as well as EUS-guided FNA of the adrenal gland, has not been described. Methods: The adrenal gland was characterized by EUS in 30 of 31 (97%) patients. EUS-guided FNA of an adrenal was performed in one patient. Anatomic correlation and ex vivo images were obtained. Results: The average dimension was 2.5 cm (range 1.4 to 3.5) × 0.8 cm (range 0.3 to 1.4) with two morphologic types: “seagull” and “elliptical.” One patient with lung cancer and a left adrenal mass with a nondiagnostic CT-guided FNA underwent EUS-guided FNA, which established the diagnosis of metastatic adenocarcinoma. Surgery was avoided. Conclusions: The left adrenal can be imaged by EUS in almost all patients. EUS-guided FNA may be useful when applied to left adrenal metastatic tumors for tissue diagnosis. (Gastrointest Endosc 1996;44:568-72.)

Section snippets

METHODS

EUS was performed in 31 consecutive patients for various indications (diagnosis and staging of gastrointestinal and lung malignancies). Of the patients in whom a final diagnosis was known by surgery or 6-month follow-up, 9 of 23 had benign lesions and 14 of 23 had malignant lesions. The left adrenal was specifically searched for in all patients. There were 11 male and 20 female patients with ages ranging from 38 to 92 years. EUS was done using the Olympus GF-UM20 echoendoscope (Olympus America

RESULTS

The left adrenal gland was detected and characterized in 30 of 31 (97%) patients. In one patient, the adrenal gland was not identified.

The echoendoscope was advanced through the esophagus into the proximal stomach. The abdominal aorta was first identified just below the gastroesophageal junction. The splenic vein was then isolated by advancing the transducer forward with a clockwise rotation. The splenic hilum was found by following the splenic vein laterally (further clockwise rotation and

DISCUSSION

The application of EUS in imaging the adrenal gland has not been described. Previously in our experience, if the adrenal was imaged, it was an incidental finding of no clinical significance. However, now that EUS may play a role in the lymph node staging of lung cancer (and adrenal metastasis occurs not infrequently), imaging the adrenal may have a clinical application.

References (29)

  • T Rosch et al.

    Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventional sonography, computed tomography, and angiography

    Gastroenterol

    (1992)
  • T Rosch et al.

    Endoscopic ultrasound in pancreatic tumor diagnosis

    Gastrointest Endosc

    (1991)
  • T Rosch et al.

    Localization of pancreatic endocrine tumors by endoscopic ultrasonography

    N Engl J Med

    (1992)
  • KJ Chang et al.

    The clinical value of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in gastrointestinal and pulmonary malignancies

    Am J Gastroenterol

    (1994)
  • F Gress et al.

    A prospective comparison study of endoscopic ultrasound (EUS), computed tomography (CT) and EUS directed fine needle aspiration biopsy (EUS/FNA) of the mediastinum in the preoperative staging of non-small cell lung cancer (NSCLCA)

    Gastrointest Endosc

    (1995)
  • G Marchal et al.

    High-resolution real-time sonography of the adrenal glands: a routine examination?

    J Ultrasound Med

    (1986)
  • F Zappasodi et al.

    Ultrasonography of the normal adrenal glands: a study using linear-array real-time equipment

    Br J Radiol

    (1986)
  • C. Mittelstaedt

    Retroperitoneum

  • E Lack et al.

    Embryology, developmental anatomy, and selected aspects of non-neoplastic pathology

  • PG Harper et al.

    Computerized axial tomography in the pretreatment assessment of small cell carcinoma of the bronchus

    Cancer

    (1981)
  • JJ. Pagani

    Non-small cell carcinoma adrenal metastasis: computed tomography and percutaneous needle biopsy in their diagnosis

    Cancer

    (1984)
  • MA Sandler et al.

    Computed tomographic evaluation of the adrenal gland in the preoperative assessment of bronchogenic carcinoma

    Radiology

    (1982)
  • D. Whittlesey

    Prospective computed tomographic scanning in the staging of bronchogenic cancer

    J Thorac Cardiovasc Surg

    (1988)
  • TW Oliver et al.

    Isolated adrenal masses in nonsmall-cell bronchogenic carcinoma

    Radiology

    (1984)
  • Cited by (0)

    From the Division of Gastroenterology, University of California, Irvine Medical Center, Orange, and the VA Medical Center, Long Beach, California.

    ☆☆

    Reprint requests: Kenneth J. Chang, MD, UCI Clinical Cancer Center, 101 The City Drive, Bldg 23, Rm 330, Orange, CA 92668.

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