Safety of biopsy in phaeochromocytoma and paraganglioma: an international, multicentre, retrospective cohort study

Safety of biopsy in phaeochromocytoma and paraganglioma: an international, multicentre, retrospective cohort study · SciRah

^aDepartment of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: liang.zhang@medsci.uu.se
^bService d'Oncologie Endocrinienne, Département d'Imagerie, Institut Gustave Roussy, Villejuif, France
^cDepartment of Endocrinology and Metabolism, Zhongshan Hospital Fudan University, Shanghai, China
^dDivision of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
^eAssistance Publique-Hôpitaux de Paris Centre, Hôpital Européen Georges Pompidou, Unité Fonctionnelle d'Hypertension Artérielle, Centre de Référence des Maladies de la Surrénale, Université Paris Cité, Paris, France
^fInserm, Équipe Labellisée Ligue Contre le Cancer, Centre de Recherche des Cordeliers, Université Paris-Cité, Sorbonne Université, Paris, France
^gDepartment of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People's Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
^hDepartment of Endocrinology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Poland
ⁱDepartment of Endocrinology and Internal Medicine, University Clinical Centre, Gdańsk, Poland
^jNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
^kDepartment of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
^lDepartment of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
^mDepartment of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
ⁿFaculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
^oDepartment of Endocrinology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
^pDepartment of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
^qDepartment of Medicine, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Wuerzburg, Wuerzburg, Germany
^rServicio de Endocrinología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
^sDepartment of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, University of Zurich, Zurich, Switzerland
^tThe LOOP Zurich-Medical Research Center, Zurich, Switzerland
^uDepartment of Medicine IV, Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
^vDepartment of Urology, Xiangya Hospital, Central South University, Changsha, China
^wEndocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
^xDepartment of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
^yUniversité Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, DMU Carte, Unité Hypertension Artérielle, Centre de Références en Maladies Rares de la Surrénale, Paris, France
^zDepartment of Endocrinology, Diabetes and Metabolism, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal
^aaEndocrinology, Diabetes, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
✉Corresponding author

Abstract

BACKGROUND: Biopsy of phaeochromocytomas and paragangliomas (PPGLs) is discouraged due to the perceived risk of catecholamine-related complications. However, a systematic review showed that this recommendation is primarily supported by case reports. We aimed to assess the safety of percutaneous biopsy in patients with PPGLs. METHODS: This international, multicentre, retrospective study included patients of any age with PPGLs referred to participating centres who had had percutaneous core-needle biopsy or fine-needle aspiration. Biopsies of head and neck paragangliomas were excluded. Participating centres completed standardised data-collection forms. The primary outcome was biopsy-related mortality rate for all patients who had biopsies performed at participating centres, given that biopsies done elsewhere that had fatal outcomes would be unlikely to be referred. Secondary outcomes included the incidence of serious catecholamine-related and non-catecholamine-related complications among all included patients. FINDINGS: Between Sep 1, 1993, and May 31, 2025, 222 patients (110 [50%] female, 112 [50%] male) underwent 234 biopsies in 19 hospitals across 11 countries. 139 (67%) of 207 patients had elevated epinephrine or norepinephrine (or metabolites) and 27 (12%) of 232 biopsies were preceded by the administration of α-adrenoceptor blockade. One (mortality rate 0·9% [95% CI 0·0-5·1]) of 106 biopsies led to death due to biopsy-related infection. Serious catecholamine-related complications occurred after four (1·7% [0·5-4·3]) of 233 biopsies and included tachyarrhythmia, hypertensive crisis, and cardiogenic shock. No serious catecholamine-related complications occurred in patients without catecholamine excess (n=59), receiving fine-needle aspiration (n=46), or after biopsy of metastatic lesions (n=114). Serious non-catecholamine-related complications occurred after ten (4·3% [2·1-7·8]) of 233 biopsies, mainly bleeding and infection. INTERPRETATION: Percutaneous biopsy of PPGLs was associated with a low mortality rate. Serious complication rates were also low, most of which were not catecholamine-related. These findings challenge current recommendations that biopsy should be avoided in suspected or confirmed PPGLs, and instead support a personalised, risk-benefit-based approach to the procedure. FUNDING: Cancerfonden. TRANSLATIONS: For the Chinese and French translations of the abstract see Supplementary Materials section.

TL;DRPercutaneous biopsy of PPGLs was associated with a low mortality rate and serious complication rates were also low, most of which were not catecholamine-related. (Semantic Scholar)

Safety of biopsy in phaeochromocytoma and paraganglioma: an international, multicentre, retrospective cohort study

Abstract

Plain-language summary

Discussion