FP29-3 Transcutaneous Biopsy of Adrenocortical Carcinoma is Rarely Helpful in Diagnosis, Potentially Harmful, but Does Not Affect Patient Outcome

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP29-Adrenal Tumors & Pheochromocytoma
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:55 AM
Room 134 (Moscone Center)

Poster Board MON-1
Andrew Williams, Gary D Hammer and Tobias Else*
University of Michigan, Ann Arbor, MI
Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The utility, sensitivity, and effect on patient outcome of transcutaneous adrenal biopsy (TAB) for large adrenal masses are unclear. This study aims to evaluate the utility, diagnostic sensitivity, and effect on patient outcome of TAB in patients with ACC. 

We conducted a retrospective review of the electronic medical records of all ACC patients who were evaluated at the University of Michigan Health System between 1991 and 2011. We evaluated the sensitivity of TAB for the final pathological diagnosis as ACCs. We also compared patients with stage I-III with and without TAB regarding patient and tumor characteristics and patient overall and tumor-free survival.

A total of 74 adrenal biopsies in 60 patients (stage I-IV) were identified. The reported risk rate was relatively high with 10.9%. Complications were usually bleeding-related, but potentially fatal in one case. We identified one patient with needle track metastasis. The sensitivity of the procedure was maximally 67.8%. For patients with stage I-III disease baseline characteristics, stage at diagnosis, adjuvant mitotane and radiation therapy were not significantly different between the TAB (n = 30) and the non-TAB (n = 242) groups. However, fewer patients in the TAB group had functional tumors, suggesting that the diagnosis of an endocrine tumor was less evident in this group. There was no significant difference in tumor-free (p = 0.8) or overall survival (p = 0.7) between patients who underwent TAB and those who did not.

In conclusion, TAB may be done for large adrenal masses in the presence of metastasis with a fair sensitivity. However, for single large adrenal masses it is unnecessary, has inadequate sensitivity, exposes patients to risk, but does not affect tumor-free or overall survival and may not need to be taken into consideration when deciding on adjuvant treatment modalities.

Disclosure: GDH: Consultant, orphagen, Founder, Atterocor, Consultant, Embera, Advisory Group Member, Embera, Consultant, HRA Pharma, Consultant, Corcept, Consultant, Isis, Advisory Group Member, orphagen, Consultant, OSI-Astella. Nothing to Disclose: AW, TE

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: T.E. Tobias Else is supported by NIH T32-DK007245