When is adrenal gland biopsy indicated?
- In patients with no history of malignancy, most incidentally discovered adrenal masses less than 4 cm in diameter are benign and should be evaluated with CT scans or MRI.
- For adrenal masses greater than 4 cm and not typical for adenoma, myelolipoma, hemorrhage, or simple cysts, surgical resection should be considered.
- In patients with histories of malignancy, an incidental adrenal mass is more often malignant and even small lesions are suspect.
- In these situations, a biopsy is indicated when noninvasive tests are inconclusive unless the presence of widespread nonadrenal metastases makes the presence or absence of adrenal metastases unlikely to change patient management.
- Adrenal biopsies are also indicated when enlarging masses are seen on follow-up imaging and the imaging characteristics are suspicious for malignancy.
