We endorse the following criteria set forth by the European Society of Endocrinology guidelines:

Consider a biopsy if ALL of the following criteria have been met:

1. Hormonally active lesion (especially pheochromocytoma) ruled out by metabolic work up

2. There is a history of extra-adrenal malignancy

3. Imaging features are not diagnostic of a benign lesion

4. Biopsy results will affect management