SAN FRANCISCO – Transcutaneous biopsy of adrenocortical carcinomas did not improve diagnosis or survival, and potentially harmed 11% of patients, in a study of 74 patients.
The study fills a gap behind general recommendations against biopsy of single adrenal masses in the absence of another known malignancy or metastasis, which had been based on fears that biopsy would spread the tumor but lacked clinical evidence, Andrew Williams said in a poster presentation at the annual meeting of the Endocrine Society.
Among 74 patients with adrenocortical carcinoma who had undergone transcutaneous biopsy of an adrenal mass between 1991 and 2011, the sensitivity of the biopsy for the final pathological diagnosis of the disease was 84% at best and as low as 51% in community settings, the retrospective review of electronic medical records found.
Among the 36 patients with stage I-III disease (confined to the adrenal gland) at the time of diagnosis, the biopsy did not significantly change choices regarding adjuvant therapy, compared with 254 patients with stage I-III disease who did not undergo transcutaneous biopsy. The baseline characteristics of these two groups were similar except that patients in the biopsy group were significantly less likely to be secreting hormones (28%) compared with the no-biopsy group (59%).
"Single adrenal masses with malignant characteristics invariably should be treated surgically, making biopsy an unnecessary procedure," reported Mr. Williams, a medical student at the University of Michigan, Ann Arbor, and his associates.
Complications from transcutaneous biopsy in 11% of all patients consisted mainly of bleeding-related events but with one potentially fatal event – needle track metastasis in one patient.
"Single adrenal masses with malignant characteristics invariably should be treated surgically, making biopsy an unnecessary procedure."
Rates of overall and tumor-free survival did not differ significantly between patients who did or did not undergo transcutaneous biopsy in either univariate analysis or multivariate analyses adjusting for age, sex, cortisol production, and adjuvant therapies.
Adrenocortical carcinomas are rare cancers with high rates of recurrence and mortality. Cumulative survival rates in the study decreased steadily to roughly 80% at 1 year, 60% at 3 years, and less than 50% at 5 years.
"Biopsy of adrenocortical carcinomas at stages confined to the adrenal gland does not significantly influence survival," Mr. Williams concluded in the poster. "Adrenal biopsy should only be considered in patients with metastasized disease and unclear tumor origin, only if it may alter the therapeutic approach and only if the adrenal is the easiest site to biopsy."
Patients who underwent biopsy in the study had a median age of 52 years (ranging from 17 to 77 years), and 54% were female. The cohort was 84% white.
Mr. Williams reported having no financial disclosures. Coinvestigator Dr. Gary D. Hammer, also at the University of Michigan, disclosed financial associations with Atterocor, Orphagen Pharmaceuticals, Embera NeuroTherapeutics, HRA Pharma, Corcept Therapeutics, Isis, and OSI-Astella.
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