Rinkesh K Bansal1, Narendra S Choudhary1, Saurabh K Patle1, Amit Agarwal1, Gagandeep Kaur2, Haimanti Sarin2, Rajesh Puri3. 1. Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India. 2. Department of Cytopathology, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India. 3. Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Sector 38, Gurgaon, Delhi, NCR, 122 001, India. purirajesh70@gmail.com.
Abstract
BACKGROUND: Fine-needle aspiration (FNA) of adrenals is needed in patients with pyrexia of unknown origin (PUO) and adrenal enlargement in absence of other diagnostic clues. Adrenals are easily accessible by endoscopic ultrasound (EUS) due to proximity; however, there is no systemic study available on FNA of adrenals in patients with PUO. The aim of this study was to evaluate the diagnostic yield and safety of EUS-FNA of enlarged adrenal in patients with PUO. METHODS: Data was analyzed from October 2010 to September 2016 at a single tertiary care center in northern India. EUS-FNA of enlarged adrenals was done in 52 patients for the etiological diagnosis of PUO in whom a definitive diagnosis could not be made with other means. RESULTS: The mean age was 48±14 years; 36 were males and 16 were females. EUS-FNA was done from the left adrenal in 50 patients and from the right sample in 2 patients. A technical success was achieved in 100% cases. The 19-G needle was used in the majority (75%) to the presence of necrotic areas in adrenals; median numbers of passes were 2. The cytopathological diagnoses were tuberculosis (n = 36), histoplasmosis (n = 13), lymphoma (n = 2), and metastasis from undiagnosed neuroendocrine tumor of lung (n = 1). Thus, a diagnosis could be made in 52/52 (100%) patients. None of the patients had any procedure-related complications. CONCLUSIONS: EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.
BACKGROUND: Fine-needle aspiration (FNA) of adrenals is needed in patients with pyrexia of unknown origin (PUO) and adrenal enlargement in absence of other diagnostic clues. Adrenals are easily accessible by endoscopic ultrasound (EUS) due to proximity; however, there is no systemic study available on FNA of adrenals in patients with PUO. The aim of this study was to evaluate the diagnostic yield and safety of EUS-FNA of enlarged adrenal in patients with PUO. METHODS: Data was analyzed from October 2010 to September 2016 at a single tertiary care center in northern India. EUS-FNA of enlarged adrenals was done in 52 patients for the etiological diagnosis of PUO in whom a definitive diagnosis could not be made with other means. RESULTS: The mean age was 48±14 years; 36 were males and 16 were females. EUS-FNA was done from the left adrenal in 50 patients and from the right sample in 2 patients. A technical success was achieved in 100% cases. The 19-G needle was used in the majority (75%) to the presence of necrotic areas in adrenals; median numbers of passes were 2. The cytopathological diagnoses were tuberculosis (n = 36), histoplasmosis (n = 13), lymphoma (n = 2), and metastasis from undiagnosed neuroendocrine tumor of lung (n = 1). Thus, a diagnosis could be made in 52/52 (100%) patients. None of the patients had any procedure-related complications. CONCLUSIONS: EUS-FNA is a safe and effective method for evaluating etiology of PUO in patients with adrenal enlargement.
Entities:
Keywords:
Adrenals; EUS-FNA; Pyrexia of unknown origin
Authors: Tiing Leong Ang; Tju Siang Chua; Kwong Ming Fock; Augustine K H Tee; Eng Kiong Teo; Kent Mancer Journal: Ann Acad Med Singapore Date: 2007-11 Impact factor: 2.473