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Fitzpatrick MJ, Sohani AR, Ly A. Uses and limitations of small-volume biopsies for the diagnosis of lymphoma. Cytopathology 2024; 35:454-463. [PMID: 38462899 DOI: 10.1111/cyt.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small-volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ehinger M, Béné MC. Morphology and multiparameter flow cytometry combined for integrated lymphoma diagnosis on small volume samples: possibilities and limitations. Virchows Arch 2024:10.1007/s00428-024-03819-3. [PMID: 38805049 DOI: 10.1007/s00428-024-03819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.
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Affiliation(s)
- Mats Ehinger
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
| | - Marie C Béné
- Faculty of Medicine, Nantes University, Nantes, France
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Pearse WB, Reid EG. Current Multidisciplinary Lymphoma and Myeloma Management for Surgeons. Surg Oncol Clin N Am 2024; 33:447-466. [PMID: 38401918 DOI: 10.1016/j.soc.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Although there are more than 100 clinically distinct lymphoid neoplasms with varied prognoses and treatment approaches, they generally share high sensitivity to glucocorticoids, cytotoxic chemotherapy, and radiation. The disease control rates for lymphoid malignancies are higher than many solid tumors, and many are curable even when presenting with extensive involvement. Novel targeted therapies have improved disease control and cure rates for nearly all subtypes of lymphoid neoplasms. Surgical oncologists will primarily be involved in obtaining biopsies of sufficient quality to allow accurate diagnosis. However, there are scenarios in which surgical intervention may be necessary to address an oncologic emergency.
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Affiliation(s)
- William B Pearse
- Division of Hematology/Oncology, University of California, San Diego Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA
| | - Erin G Reid
- Division of Hematology/Oncology, University of California, San Diego Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093, USA.
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Pizzi M, Sbaraglia M, Dal Santo L, De Bartolo D, Santoro L, Scarmozzino F, Mussolin L, Pillon M, Piazza F, Trentin L, Dei Tos AP. Higher accuracy of surgical over core needle biopsy for the diagnosis of lymphoproliferative disorders. Int J Lab Hematol 2023. [PMID: 36871956 DOI: 10.1111/ijlh.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION The diagnosis of lymphoproliferative disorders (LPDs) is based on histological evaluation of representative tissue samples. Despite surgical excision biopsies (SEBs) are reference procedures for such diagnoses, lymph node core needle biopsies (LNCBs) are increasingly performed. The diagnostic yield of LNCB is, however, debated and few studies have compared the reproducibility of LNCB and SEB findings. METHODS To address the diagnostic value of LNCB and SEB, the present study considered a retrospective series of 43 paired LNCB/SEB samples. After histological revision, concordance rates between matched LNCB/SEB samples were evaluated, assuming SEB as gold standard procedure. The actionability of LNCB and SEB-based diagnoses (i.e., relevance for planning further medical interventions) was also assessed. RESULTS Overall, LNCB provided actionable diagnoses in 39/43 (90.7%) cases, but a consistent subset of them (7/39 [17.9%]) turned out to be wrong at SEB. The cumulative diagnostic inaccuracy of LNCB (i.e., inadequate samples plus wrong diagnoses) was 25.6% and the mean diagnostic delay in such cases was 54.2 days. CONCLUSIONS Although limited by selection biases due to its retrospective nature, this study highlights the intrinsic limitations of LNCB for the diagnosis of LPDs. SEB remains the gold standard procedure and should be performed in all suitable cases.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Luca Dal Santo
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Debora De Bartolo
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Luisa Santoro
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Federico Scarmozzino
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Lara Mussolin
- Oncohematology Unit, Department of Children and Women's Health, University of Padua School of Medicine, Padua, Italy
| | - Marta Pillon
- Oncohematology Unit, Department of Children and Women's Health, University of Padua School of Medicine, Padua, Italy
| | - Francesco Piazza
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Livio Trentin
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
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Incorporation of ultrasound-guided core biopsy with flow cytometry to assist the diagnosis of cervical lymphoma. Eur Arch Otorhinolaryngol 2023; 280:1437-1446. [PMID: 36322178 DOI: 10.1007/s00405-022-07705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The main purpose of surgery for cervical lymphoma is only for tissue sampling. To establish a patient-friendly diagnostic approach, we investigated the feasibility of ultrasound-guided core biopsy with flow cytometry in the patients with suspected cervical lymphoma. METHODS We prospectively recruited patients with suspected cervical lymphoma from Nov 2017 till Jan 2021 in a referral medical center and performed retrospective interpretation of the prospectively acquired data. Ultrasound-guided core biopsy as the tissue sampling approach for the targeted lesions was performed in all patients. The ultrasound-guided core biopsy samples were analyzed by immunohistochemical stains and flow cytometry. The sample quality and the rate of definite and decisive diagnosis obtained by ultrasound-guided core biopsy alone and ultrasound-guided core biopsy with flow cytometry were evaluated. RESULTS Total 81 consecutive patients were recruited for analysis. All ultrasound-guided core biopsy samples were qualified for analysis of pathology and flow cytometry. Pathologically, the diagnoses were definite and compatible with their flow cytometry results in 70 patients (86.42%). Either newly-diagnosed or recurrent cervical lymphoma/lymphoproliferative disorders with histologic transformation could be diagnosed by ultrasound-guided core biopsy with flow cytometry. Nine of the 11 patients with pathologically indefinite diagnosis became clinically decisive when flow cytometry was incorporated into the process, which improved the rate of decisive diagnosis to 98.77% (Odds ratio [95% CI]: 6.21 [1.28, 58.96]). CONCLUSION Ultrasound-guided core biopsy combined with flow cytometry is suggested to serve as the first-line and patient-friendly diagnostic approach for the patients with suspected cervical lymphoma.
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Stacey A, Marks AJ, Naresh KN. Variant histology in nodular lymphocyte predominant Hodgkin lymphoma in an adult population: disease investigations and characteristics from a retrospective cohort. J Clin Pathol 2023; 76:137-140. [PMID: 35483890 DOI: 10.1136/jclinpath-2022-208190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
A subset of variant histological patterns of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) has been associated with advanced disease stage and increased recurrence risk. Histopathology reports on core needle (CNB) and/or surgical excision biopsies (SEB) for 33 adult patients with NLPHL were examined for variant histology prevalence and association with disease stage and clinical outcome. Variant histological pattern was present in 13/33 patients (39%). Obtained tissue was inadequate for diagnosis in 1/23 (4.3%) cases of CNB. Variant histology was associated with stage IV disease at presentation (p<0.001). While SEB should be the procedure of choice in workup of patients for a diagnosis of NLPHL, CNB is an alternate option when SEB is contraindicated or difficult to undertake. Diagnostic reports should specifically note presence of variant histological patterns. Although late-stage disease was associated with progression or recurrence, overall prognosis is excellent for patients with NLPHL.
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Affiliation(s)
- Arthur Stacey
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Kikkeri N Naresh
- Histopathology, Imperial College London Centre for Haematology, London, UK.,Section of Pathology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Core Needle Biopsy in Lymphoma Diagnosis: The Diagnostic Performance and the Role of the Multidisciplinary Approach in the Optimization of Results. Am J Surg Pathol 2023; 47:111-123. [PMID: 36395467 DOI: 10.1097/pas.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To compare the diagnostic accuracy of core needle biopsies (CNBs) and surgical excisional biopsies (SEBs), samples of lymphoid proliferation from a single institution from 2013 to 2017 (N=476) were divided into groups of CNB (N=218) and SEB (N=258). The diagnostic accuracy of these samples was evaluated as a percentage of conclusive diagnosis, according to the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues . The contribution of clinical data, the assessment of sample adequacy by a pathologist during the procedure, the number and size of fragments, the needle gauge, the ancillary tests, and the type of lymphoid proliferation were also examined. The diagnostic accuracy of SEB was 97.3% and CNB 91.3% ( P =0.010). Additional factors considered essential for establishing the final diagnosis in some cases were: clinical information (20.6% CNB, 7.4% SEB; P <0.001); immunohistochemistry (96.3% CNB, 91.5% SEB; P =0.024); flow cytometry (12% CNB, 6.8% SEB; P =0.165); and other complementary tests (8.2% CNB, 17.3% SEB; P =0.058). Factors that did not influence performance were the evaluation of sample adequacy during the procedure, the number and size of fragments, and the needle gauge. Increased percentage of nondiagnostic CNB was observed in T-cell lymphomas (30%), followed by classic Hodgkin lymphoma (10.6%). The main limitation of CNB was the evaluation of morphologically heterogenous diseases. CNB is useful and safe in lymphoma diagnosis provided it is carried out by a team of experienced professionals. Having an interventional radiology team engaged with pathology is an essential component to achieve adequate rates of specific diagnoses in CNB specimens.
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Desai SH, Mwangi R, Ng WL, King RL, Maurer MJ, Cerhan JR, Feldman AL, Farooq U, Mou E, Habermann TM, Thompson CA, Wang Y, Witzig TE, Nowakowski GS. Increasing tissue requirements in lymphoma trials may exclude patients with high-risk disease or worse prognosis. Blood Adv 2022; 6:6180-6186. [PMID: 36170803 PMCID: PMC9791316 DOI: 10.1182/bloodadvances.2022007569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 01/22/2023] Open
Abstract
An enhanced understanding of the molecular heterogeneity of diffuse large B-cell lymphoma (DLBCL) has opened the door to clinical trials evaluating novel agents with subtype-specific activity. It is an emerging question whether core needle biopsies (CNB) can adequately meet the increasing tissue requirements of these clinical trials. This can potentially lead to selective enrollment of patients who can undergo excisional biopsy (EB). It is also important to know whether patients who can undergo extensive diagnostic work up differ in their disease characteristics and outcomes from those who cannot. In this observational study, we describe the characteristics, outcomes, and adequacy of diagnostic tissue in patients with newly diagnosed DLBCL and primary mediastinal large B-cell lymphoma who underwent EB vs CNB. Of the 1061 patients, 532 (49.8%) underwent EB and 529 (50.1%) underwent CNB. A significantly higher proportion of patients with CNB had advanced stage disease, an international prognostic index of ≥3, and inadequate tissue for molecular analyses. Patients with CNB had significantly worse 5-year event-free survival (67.6% vs 56.9%; hazard ratio [HR], 0.76; confidence interval [CI]95, 0.6-0.9, P < .001) and 5-year overall survival (76.4% vs 69.2%; HR, 0.8; CI95, 0.6-0.9, P < .001). Thus, patients who underwent CNB have poor-risk features and inferior outcomes on frontline chemoimmunotherapy, are more likely to have inadequate tissue for molecular analyses, and might not meet the tissue requirements of biomarker-driven clinical trials. Thus, the increasing tissue requirements of biomarker-driven clinical trials may result in the exclusion of patients with high-risk DLBCL who need novel agents.
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Affiliation(s)
- Sanjal H. Desai
- Division of Hematology, Department of Medicine
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | | | | | - Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Umar Farooq
- Department of Hematology, Oncology, Blood and Bone Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA
| | - Eric Mou
- Department of Hematology, Oncology, Blood and Bone Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA
| | | | | | - Yucai Wang
- Division of Hematology, Department of Medicine
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Lymph node excisions provide more precise lymphoma diagnoses than core biopsies: a French Lymphopath network survey. Blood 2022; 140:2573-2583. [PMID: 35797472 DOI: 10.1182/blood.2022015520] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
According to expert guidelines, lymph node surgical excision is the standard of care for lymphoma diagnosis. However, core needle biopsy (CNB) has become widely accepted as part of the lymphoma diagnostic workup over the past decades. The aim of this study was to present the largest multicenter inventory of lymph nodes sampled either by CNB or surgical excision in patients with suspected lymphoma and to compare their diagnostic performance in routine pathologic practice. We reviewed 32 285 cases registered in the French Lymphopath network, which provides a systematic expert review of all lymphoma diagnoses in France, and evaluated the percentage of CNB and surgical excision cases accurately diagnosed according to the World Health Organization classification. Although CNB provided a definitive diagnosis in 92.3% and seemed to be a reliable method of investigation for most patients with suspected lymphoma, it remained less conclusive than surgical excision, which provided a definitive diagnosis in 98.1%. Discordance rates between referral and expert diagnoses were higher on CNB (23.1%) than on surgical excision (21.2%; P = .004), and referral pathologists provided more cases with unclassified lymphoma or equivocal lesion through CNB. In such cases, expert review improved the diagnostic workup by classifying ∼90% of cases, with higher efficacy on surgical excision (93.3%) than CNB (81.4%; P < 10-6). Moreover, diagnostic concordance for reactive lesions was higher on surgical excision than CNB (P = .009). Overall, although CNB accurately diagnoses lymphoma in most instances, it increases the risk of erroneous or nondefinitive conclusions. This large-scale survey also emphasizes the need for systematic expert review in cases of lymphoma suspicion, especially in those sampled by using CNB.
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Jassim TK, Ferreira JE, Murphy MB, Piecoro DW, Allison DB. The use of diagnostic patterns for interventional cytopathology during rapid on-site evaluation and final classification. Semin Diagn Pathol 2022; 39:394-404. [PMID: 35725678 DOI: 10.1053/j.semdp.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022]
Abstract
Pathologist-performed fine-needle aspiration, or interventional cytopathology, is a minimally invasive, highly accurate technique for sampling and diagnosing palpable lesions. Utilizing cytomorphologic patterns during rapid onsite evaluation (ROSE) and final classification is one of many strategies that an interventional cytopathologist can employ to simplify the diagnostic approach. Herein, we provide an overview of the salient cytomorphologic patterns encountered in common specimens obtained by the interventional cytopathologist, including major salivary glands, the thyroid gland, and superficial lymph nodes. The topics covered should provide a primer for those interested in utilizing a site-specific, pattern-based approach to cytopathologic evaluation. In summary, cytomorphologic patterns can be used during ROSE to establish adequacy, build a differential diagnosis, and to appropriately triage the specimen for additional investigation, such as microbiology cultures, a liquid-based preparation, a cell block preparation, flow cytometry, chemical analysis, or molecular diagnostic tests. Finally, this approach can be applied at the time of diagnosis to suggest additional ancillary studies, such as immunohistochemistry, and to inform accurate and definitive classification.
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Affiliation(s)
- Treeva K Jassim
- University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA
| | - Juanita E Ferreira
- University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA
| | - Melissa B Murphy
- University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA
| | - Dava W Piecoro
- University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA
| | - Derek B Allison
- University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA; University of Kentucky College of Medicine, Department of Urology, Lexington, KY 40536, USA; University of Kentucky, Markey Cancer Center, Lexington, KY 40536, USA.
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Lieu D. FNA 2.0: Value of cytopathologist-performed ultrasound-guided core-needle biopsy. Semin Diagn Pathol 2022; 39:426-435. [PMID: 35752516 DOI: 10.1053/j.semdp.2022.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
In the late 20th century, pathologist-performed palpation-guided fine-needle aspiration (PG-FNA) of superficial masses was popularized in the United States. It brought pathologists out of the laboratory to see patients and the hope of decreasing the need for surgical biopsy for diagnostic purposes. This first iteration of minimally invasive tissue sampling could be informally called FNA 1.0. FNA 1.0 had shortcomings, such as detection of invasion in breast cancer, precise subtyping of lymphomas, aspiration of fibrous lesions, and diagnosis of sarcomas. The early 21st century brought new hope. Ultrasound-guidance became commonly used to guide FNA of both palpable and non-palpable masses. Ultrasound-guided core-needle biopsy was available to complement FNA in select cases. Flow cytometry, immunohistochemistry, fluorescent in-situ hybridization, and genomic studies could be done on cell block and core biopsy specimens. These advances in minimally invasive tissue diagnosis could be informally called FNA 2.0. In particular, pathologist-performed ultrasound-guided core-needle biopsy can overcome many of the criticisms and shortcomings of FNA. As pathologists were once leaders in palpation-guided fine-needle aspiration, they now have the opportunity to add pathologist-performed ultrasound-guided core-needle biopsy to their skill set and emerge once again as leaders in minimally invasive tissue diagnosis. This will bring pathology to the next level.
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Affiliation(s)
- David Lieu
- University of California, Los Angeles/Fine Needle Aspiration Medical Group, 320 S. Garfield Ave. # 278, Alhambra, CA 91801 United States.
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Abstract
PURPOSE OF REVIEW Richter's transformation (RT) occurs when chronic (CLL) transforms into an aggressive lymphoma. Despite improvements in the treatment of CLL, prognosis for RT remains poor. Here, we review current literature of RT, with a focus on novel treatment options. RECENT FINDINGS Efforts are underway to improve outcomes for patients with RT. While small molecule inhibitors have limited efficacy as monotherapy, recent developments combining them with chemo-immunotherapy show promise. Studies exploring the use of cellular therapies including chimeric antigen receptor T-cells and bispecific antibodies are ongoing. The current treatment paradigm for RT is to enroll these patients on a clinical trial when available, together with consultation for a consolidative allogeneic stem cell transplant. Trials investigating novel combinations and cellular therapy are ongoing. Determining predictive variables of transformation is imperative to design studies that allow for early identification and intervention for patients with RT.
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Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
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Tembhare PR, Chatterjee G, Chaturvedi A, Dasgupta N, Khanka T, Verma S, Ghogale SG, Deshpande N, Girase K, Sengar M, Bagal B, Jain H, Shetty D, Rajpal S, Patkar N, Agrawal T, Epari S, Shet T, Subramanian PG, Gujral S. Critical Role of Flow Cytometric Immunophenotyping in the Diagnosis, Subtyping, and Staging of T-Cell/NK-Cell Non-Hodgkin's Lymphoma in Real-World Practice: A Study of 232 Cases From a Tertiary Cancer Center in India. Front Oncol 2022; 12:779230. [PMID: 35299754 PMCID: PMC8923658 DOI: 10.3389/fonc.2022.779230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/26/2022] [Indexed: 01/18/2023] Open
Abstract
Background T-cell/NK-cell non-Hodgkin’s lymphoma (T/NK-NHL) is an uncommon heterogeneous group of diseases. The current classification of T/NK-NHL is mainly based on histopathology and immunohistochemistry. In practice, however, the lack of unique histopathological patterns, overlapping cytomorphology, immunophenotypic complexity, inadequate panels, and diverse clinical presentations pose a great challenge. Flow cytometric immunophenotyping (FCI) is a gold standard for the diagnosis, subtyping, and monitoring of many hematological neoplasms. However, studies emphasizing the role of FCI in the diagnosis and staging of T/NK-NHL in real-world practice are scarce. Methods We included T-cell non-Hodgkin’s lymphoma (T-NHL) patients evaluated for the diagnosis and/or staging of T/NK-NHL using FCI between 2014 and 2020. We studied the utility of FCI in the diagnosis and subtyping of T/NK-NHL and correlated the FCI findings with the results of histopathology/immunohistochemistry. For correlation purposes, patients were categorized under definitive diagnosis and subtyping, inadequate subtyping, inadequate diagnosis, and misdiagnosis based on the findings of each technique. Results A total of 232 patients were diagnosed with T/NK-NHL. FCI findings provided definitive diagnoses in 198 patients and subtyping in 187/198 (95.45%) patients. The correlation between FCI and histopathological/immunohistochemistry results (n = 150) demonstrated an agreement on the diagnosis and subtyping in 69/150 (46%) patients. Of the remaining cases, the diagnosis and subtyping were inadequate in 64/150 (42.7%), and 14/150 (9.33%) were misdiagnosed on histopathology/immunohistochemistry results. FCI provided definitive diagnosis and subtyping in 51/64 (79.7%) patients. Among these, 13 patients diagnosed with peripheral T-cell lymphoma not-otherwise-specified were reclassified (angioimmunoblastic T-cell lymphoma (AITL)-11 and prolymphocytic leukemia-2) on FCI. It corrected the diagnosis in 14 patients that were misdiagnosed (6 B-cell NHL (B-NHL), 3 Hodgkin’s lymphoma, 1 acute leukemia, and 1 subcutaneous panniculitis-like T-cell lymphoma) and misclassified (3 T-NHL) on histopathological results. AITL was the commonest T-NHL misclassified on histopathological results. FCI also confirmed the definite involvement in 7/83 (8.4%) and 27/83 (32.5%) bone marrow (BM) samples reported as suspicious and uninvolved, respectively, on histopathological evaluation. Conclusion AITL was the most frequently diagnosed T/NK-NHL in this study. FCI provided a distinct advantage in detecting BM involvement by T/NK-NHL, especially in patients with low-level involvement. Overall, our study concluded that FCI plays a critical role in the diagnosis, subtyping, and staging of T/NK-NHL in real-world practice.
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Affiliation(s)
- Prashant R Tembhare
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Gaurav Chatterjee
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Anumeha Chaturvedi
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Niharika Dasgupta
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Twinkle Khanka
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Shefali Verma
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sitaram G Ghogale
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nilesh Deshpande
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Karishma Girase
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Dhanalaxmi Shetty
- Department of Cancer Cytogenetics, ACTREC, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sweta Rajpal
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Nikhil Patkar
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Tushar Agrawal
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
| | - Papagudi G Subramanian
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India
| | - Sumeet Gujral
- Hematopathology Laboratory, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Center, Homi Bhabha National Institute (HBNI) University, Mumbai, India.,Department of Pathology, Tata Memorial Center, HBNI University, Mumbai, India
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14
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Kurch L, Georgi TW, Monecke A, Seehofer D, Borte G, Sabri O, Kluge R, Heyn S, Pierer M, Platzbecker U, Kayser S. Vital Hepatic Lymphoma Residuum or Excessive Immune Response? Challenging Treatment Decisions in a Patient With Systemic Lupus Erythematosus and Liver-Dominant Diffuse Large B-Cell Lymphoma: Case Report. Front Oncol 2022; 11:798757. [PMID: 35117998 PMCID: PMC8803907 DOI: 10.3389/fonc.2021.798757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
A 28-year-old female patient with active and difficult-to-treat systemic lupus erythematosus (SLE) was diagnosed with liver-dominant diffused large B-cell lymphoma. Repeated response 18F-FDG-PET studies showed persistently high, and, despite intensified immunochemotherapy, further increasing metabolic activity of one of the hepatic lymphoma residuals, whereas all other initial lymphoma manifestations had achieved complete metabolic remission. As biopsy of the 18F-FDG-PET-positive liver residual turned out to be inconclusive, complete resection was performed. Subsequent histopathological examination, however, revealed only necrotic tissue. Thus, no further lymphoma treatment was scheduled. The patient undergoes regular surveillance and is disease-free 13 months after resection. Similarly, treatment of SLE is no longer required due to lack of activity already after the first two cycles of lymphoma treatment. The case shows how closely SLE and diffused large B-cell lymphoma can be connected and stresses the importance of interdisciplinary treatment approaches. In the future, artificial intelligence may help to further classify 18F-FDG-PET-positive lymphoma residuals. This could lead to an increase of the positive predictive value of interim- and end-of-treatment 18F-FDG-PET. The patient’s point of view enables another instructive perspective on the course of treatment, which often remains hidden to treating physicians due to lack of time in clinical routine.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
- *Correspondence: Lars Kurch,
| | - Thomas W. Georgi
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Astrid Monecke
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Gudrun Borte
- Department of Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Simone Heyn
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Pierer
- Department of Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Sabine Kayser
- Department of Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Makarenko VV, DeLelys ME, Hasserjian RP, Ly A. Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories. Cancer Cytopathol 2021; 130:144-153. [PMID: 34661975 DOI: 10.1002/cncy.22523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite widespread clinical use, lymph node fine-needle aspiration cytology (LN-FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely due to reports of lower diagnostic performance, inconsistent terminology use in cytopathology diagnostic reports, and only limited data on the clinical implications of LN-FNAC diagnoses. Recently, a uniform LN-FNAC cytopathological diagnostic reporting system was proposed (the Sydney System). This study evaluated LN-FNAC diagnostic performance and risks of malignancy associated with the proposed diagnostic categories. METHODS LN-FNAC specimens obtained in 2018-2019, with and without concurrent core biopsy, to evaluate for suspected lymphoma were analyzed (n = 349). LN-FNAC diagnoses were compared with final diagnoses obtained via subsequent tissue biopsy and/or clinical assessment. RESULTS The mean patient age was 57.6 years, and 41% were female. LN-FNAC was the initial diagnostic test in 223 (63.9%), and it was used to evaluate for recurrence in 126 (36.1%). LN-FNAC diagnosed 202 hematological malignancies (57.9%), 23 nonhematological malignancies (6.6%), and 124 reactive processes (35.5%). Subsequent tissue biopsy was performed in 42 (12%). The risks of malignancy per diagnostic category were as follows: inadequate, 58.3%; benign, 6.4%; atypical, 69.2%; suspicious, 96.7%; and malignant, 99.3%. LN-FNAC demonstrated up to 96.3% sensitivity, 91.91% specificity, and 87.35% accuracy. Optimal specimen quality and the use of intradepartmental consultation reduced diagnostic error rates in FNA cases without concurrent core biopsy (P = .029 and P = .0002 respectively). CONCLUSIONS LN-FNAC is accurate and reliable for the diagnosis of lymphoma. Inadequate LN-FNAC samples should be resampled due to a significant associated risk of lymphoma. The diagnostic performance of LN-FNAC may be improved with good specimen quality and reviews by multiple pathologists. Understanding the risks of malignancy associated with LN-FNAC diagnostic categories will help to guide optimal patient management.
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Affiliation(s)
- Vladislav V Makarenko
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle E DeLelys
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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16
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Hoffmann P, Balik M, Hoffmannova M, Spacek J, Vanasek J, Rezac A, Dvorak P. Long-term experience with percutaneous biopsies of pelvic lesions using CT guidance. Sci Prog 2021; 104:368504211058555. [PMID: 34918561 PMCID: PMC10450592 DOI: 10.1177/00368504211058555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the accuracy, efficiency, complication rate, technical features, and relations among followed parameters of CT-guided percutaneous biopsies of the pelvic lesions. 140 biopsies in 136 patients for tumors, sizes 17-160 mm in largest diameter, were carried out in patients with probable tumorous pelvic process within ten years period. The patients were women in 77 cases and men in 59 cases, aged 21 to 87 years. The lesions´ size varied from 17 mm to 160 mm in largest diameter. In 135 biopsies (96.4%) results were true positive or true negative; only 5 procedures (3.6%) were histologically false negative and had to be verified surgically. Metastatic affection was the most common diagnosis (26.4%). Lymphomas were diagnosed in 25%; serous adenocarcinoma of ovary or uterine tube was verified in 15.7% of cases. Totally 7 complications (5%) were confirmed, all were minor hemorrhages. A statistically significant relation between the complication rate and hypervascular character (p = 0.00004), and between needle gauge and histological accuracy (p = 0.00429) was revealed. Core needle biopsy using percutaneous approach and CT guidance had a high overall accuracy in determining the final histological diagnosis including subtyping. Concurrently, the complication incidence was low.
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Affiliation(s)
- Petr Hoffmann
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Michal Balik
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Martina Hoffmannova
- Faculty of Education, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Spacek
- Department of Urology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Vanasek
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Adam Rezac
- Department of Gynecology and Obstetrics, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Petr Dvorak
- Department of Radiology, Charles University Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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17
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Wight J, Hamad N, Campbell BA, Ku M, Lee K, Rose H, Armytage T, Latimer M, Lee HP, Lee ST, Dickinson M, Khor R, Verner E. Diffuse large B-cell lymphoma: A consensus practice statement from the Australasian Lymphoma Alliance. Intern Med J 2021; 52:1609-1623. [PMID: 34532916 DOI: 10.1111/imj.15533] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/29/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype, accounting for 30-40% of lymphoma diagnoses. Though aggressive, cure is achievable in approximately 60% of cases with primary chemo-immunotherapy, and in a further substantial minority by salvage therapy and autologous stem cell transplantation. Despite promising activity in early phase clinical trials, no intensified or novel treatment regimen has improved outcomes over R-CHOP21 in randomised studies. However, there remain several areas of controversy including the most appropriate prognostic markers, CNS prophylaxis and the optimal treatment for patients with high-risk disease. This position statement presents an evidence-based synthesis of the literature for application in Australasian practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Wight
- Townsville University Hospital, Townsville, Australia.,Austin Health, Heidelberg, Australia.,The University of Melbourne, Melbourne, Australia.,James Cook University, Townsville, Australia
| | - N Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Australia.,School of Medicine, Sydney, University of Notre Dame Australia.,St Vincent's Clinical School, Sydney, University of New South UK
| | - B A Campbell
- Department of Radiation oncology, Peter MacCallum Cancer Centre, Parkville, Victoria.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria
| | - M Ku
- St Vincent's Hospital, Melbourne, Victoria
| | - K Lee
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Anatomical Pathology Department, NSW Health Pathology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - H Rose
- University Hospital Geelong, Victoria.,School of Medicine, Deakin University Geelong, Victoria
| | - T Armytage
- Department of haematology, Gosford Hospital, Gosford, New South, UK
| | - M Latimer
- Canberra Hospital, Canberra, Australia.,Australian National University, Canberra, Australia
| | - H P Lee
- Flinders Medical Centre, Adelaide, Australia
| | - S T Lee
- Austin Health, Heidelberg, Australia
| | - M Dickinson
- The University of Melbourne, Melbourne, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Victoria
| | - R Khor
- Austin Health, Heidelberg, Australia
| | - E Verner
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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18
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Silva do Nascimento J, Maués T, da Silva Leite J, Reis Ferreira AM, Gonçalves Ferreira MDL. Core-Needle Biopsy Efficacy in Histopathology Diagnosis of Canine Multicentric Lymphoma. Top Companion Anim Med 2021; 45:100561. [PMID: 34260990 DOI: 10.1016/j.tcam.2021.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
Core-needle biopsy (CNB) is now widely used to diagnose and classify human lymphoma. Few studies, however, have reported the use of CNB in veterinary medicine for dogs with suspected lymphoma. The present study evaluated the efficacy of CNB sample collection to diagnose canine multicentric lymphoma morphology. 16 dogs of varying breeds with generalized peripheral lymphadenopathy and cytopathologic features suggestive of lymphoma were enrolled in the study. CNB followed by lymphadenectomy of the left popliteal lymph node was performed. Both samples underwent histopathologic evaluation. Among the 16 dogs, 14 had lymphoma. CNB was positive for lymphoma in 12 (85.7%) of these 14 dogs. CNB analysis for diagnosing dogs with multicentric lymphoma exhibited a sensitivity of 86% and a specificity of 100%. CNB was effective in generalized lymphadenopathies toward achieving a differential diagnosis and microscopic evaluation of multicentric lymphoma in dogs, revealing essential features for morphologic classification, such as cell size, histopathologic type, and grade.
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Affiliation(s)
- Juliana Silva do Nascimento
- Professor Firmino Mársico Filho Veterinary Teaching Hospital (HUVET), Faculty of Veterinary, Universidade Federal Fluminense, Postal adress: Avenida Almirante Ary Parreiras, 507 - Icaraí, Niterói, Rio de Janeiro, Brazil
| | - Tábata Maués
- Professor Firmino Mársico Filho Veterinary Teaching Hospital (HUVET), Faculty of Veterinary, Universidade Federal Fluminense, Postal adress: Avenida Almirante Ary Parreiras, 507 - Icaraí, Niterói, Rio de Janeiro, Brazil,.
| | - Juliana da Silva Leite
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary, Universidade Federal Fluminense, Postal adress: Av. Alm. Ary Parreiras, 503, Icaraí, Niterói, Rio de Janeiro, Brazil
| | - Ana Maria Reis Ferreira
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary, Universidade Federal Fluminense, Postal adress: Av. Alm. Ary Parreiras, 503, Icaraí, Niterói, Rio de Janeiro, Brazil
| | - Maria de Lourdes Gonçalves Ferreira
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary, Universidade Federal Fluminense, Postal adress: Av. Alm. Ary Parreiras, 503, Icaraí, Niterói, Rio de Janeiro, Brazil
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19
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Krarup Sigaard R, Wennervaldt K, Munksgaard L, Rahbek Gjerdrum LM, Homøe P. Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision. Acta Oncol 2021; 60:904-910. [PMID: 34003078 DOI: 10.1080/0284186x.2021.1916999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Denmark, fine needle aspiration is the standardized tool for obtaining tissue samples from lymph nodes (LN) of the neck. However, because of a low specificity toward lymphomas, LNs suspicious for this disease are often surgically removed and examined. International studies have implied that a core needle biopsy (CNB) is sufficient for detecting lymphomas, thereby potentially avoiding surgery. However, all studies have been conducted retrospectively and the goal of this prospective study was to find the true sensitivity of CNB. MATERIAL AND METHODS Fifty-seven patients were enrolled in the study, one was excluded due to lack of CNB material. LNs suspected for lymphoma were surgically removed from the neck, whereafter a CNB was obtained from the removed LN. The CNB and the remaining part of the LN were sent to the Department of Pathology for further processing and the samples were blinded and examined by two pathologists separately. A consensus diagnosis was reached in cases with divergent diagnostic proposals. Sensitivity of the CNB method in comparison to whole tissue sections for lymphoma diagnosis was calculated. RESULTS The CNB method gave the correct diagnosis in 66% of lymphoma cases, was inconclusive in 14% and gave an incorrect lymphoma subtype in 18%. In 2% the CNB wrongly resulted in a benign diagnosis. CNB was correct in all the non-lymphoma cases; thereby retaining a specificity of 100%. CONCLUSION This prospective study found a sensitivity of 66% for diagnosing lymphoma with a CNB. As the CNB in this study was obtained under optimal conditions, unlike in clinical practice, we conclude that CNB cannot be recommended as a standard tool for diagnosing lymphomas.
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Affiliation(s)
- Rasmus Krarup Sigaard
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Kasper Wennervaldt
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Lars Munksgaard
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Lise Mette Rahbek Gjerdrum
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Ito Y, Maeshima AM, Hatta S, Saito Y, Fujino T, Makita S, Fukuhara S, Munakata W, Taniguchi H, Suzuki T, Maruyama D, Sone M, Izutsu K. Use of Core-Needle Biopsy for the Diagnosis of Malignant Lymphomas in Clinical Practice. Acta Haematol 2021; 144:641-648. [PMID: 34139685 DOI: 10.1159/000516589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/17/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Excisional biopsy (EB) is considered the gold standard for lymphoma diagnosis. Although recent advances in interventional radiology enable sampling with core-needle biopsy (CNB), only few studies evaluated the utility of CNB compared to that of EB. METHODS We analyzed patients with lymphoma who had a diagnostic biopsy at the National Cancer Center Hospital during 2002-2017. We investigated the clinical and pathological characteristics of CNB in 2017. RESULTS The proportion of CNB utility in total biopsy procedures had increased from 11 to 48% during the 15 years. In 2017, CNB was opted more frequently than EB for a biopsy of superficial, abdominal, or anterior mediastinal lesions. Only one out of 72 patients who had CNB required re-biopsy with EB because of insufficiency. The incidence of complications was comparable between CNB and EB: 2 (4%) cases of minor bleeding with CNB and 1 (8%) case of minor bleeding with EB. The median time from the first visit to biopsy was significantly shorter with CNB (5.5 days) than with EB (15 days). CONCLUSION There is an increasing trend in the utility of CNB. CNB is a less invasive method with shorter time to biopsy and can be considered an alternative to EB.
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Affiliation(s)
- Yuta Ito
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan,
| | | | - Shunsuke Hatta
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Yo Saito
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Fujino
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology National Cancer Center Hospital, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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21
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Siddiqui RS, Ferman D, Tuli S, Kemeny MM. Diffuse Large B-Cell Lymphoma of the Left Upper Extremity Mimicking a Sarcoma. Cureus 2021; 13:e15588. [PMID: 34277209 PMCID: PMC8270068 DOI: 10.7759/cureus.15588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/05/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) can arise in both lymph nodes and extranodal sites. DLBCLs rarely present in the soft tissue of the upper extremity. We report a case of a 64-year-old woman who presented with a large left upper arm mass and underwent surgical resection under the presumptive diagnosis of sarcoma but the final pathology showed DLBCL. Sarcomas are common malignant tumors of the soft tissue of the extremities, but lymphomas also occasionally present as a soft tissue mass. It is important to keep lymphomas in mind in order to avoid unnecessary surgical excisions.
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Affiliation(s)
- Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, Jamaica, USA
| | - Debra Ferman
- Department of Oncology, Queens Cancer Center, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, Jamaica, USA
| | - Sandeep Tuli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, Jamaica, USA
| | - M Margaret Kemeny
- Department of Surgical Oncology, Queens Cancer Center, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, Jamaica, USA
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22
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Batool A, Hazafa A, Ahmad S, Khan HA, Abideen HMZ, Zafar A, Bilal M, Iqbal HMN. Treatment of lymphomas via regulating the Signal transduction pathways by natural therapeutic approaches: A review. Leuk Res 2021; 104:106554. [PMID: 33684680 DOI: 10.1016/j.leukres.2021.106554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Lymphoma is a heterogeneous group of malignancies, which comprises 4.2 % of all new cancer cases and 3.3 % of all cancer deaths in 2019, globally. The dysregulation of immune system, certain bacterial or viral infections, autoimmune diseases, and immune suppression are associated with a high risk of lymphoma. Although several conventional strategies have improved during the past few decades, but their detrimental impacts remain an obstacle to be resolved. However, natural compounds are considered a good option in the treatment of lymphomas because of their easy accessibility, specific mode of action, high biodegradability, and cost-effectiveness. Vegetables, fruits, and beverages are the primary sources of natural active compounds. The present review investigated the activities of different natural medicinal compounds including curcumin, MK615, resveratrol, bromelain, EGCG, and Annonaceous acetogenins to treat lymphomas. Moreover, in vitro and in vivo studies, classification, risk factors, and diagnosis of lymphoma are also discussed in the present review. The accumulated data proposed that natural compounds regulate the signaling pathways at the level of cell proliferation, apoptosis, and cell cycle to exhibit anti-lymphoma activities both in-vivo and in-vitro studies and suggested that these active compounds could be a good therapeutic option in the treatment of different types of lymphomas.
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Affiliation(s)
- Ammara Batool
- Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisalabad, 38000, Pakistan
| | - Abu Hazafa
- Department of Biochemistry, Faculty of Sciences, University of Agriculture, Faisalabad, 38000, Pakistan; International Society of Engineering Science and Technology, Coventry, CV1 5EH, United Kingdom.
| | - Saeed Ahmad
- Centre of Biotechnology and Microbiology, University of Peshawar, Peshawar, 25120, Pakistan
| | - Hamid Ali Khan
- Institute of Biological Sciences, Sarhad University of Science and Information Technology, Peshawar, 25000, Pakistan
| | - Hafiz M Z Abideen
- Institute of Public Health, The University of Lahore, Lahore, 54590, Pakistan
| | - Ayesha Zafar
- Institute of Biochemistry and Biotechnology, Faculty of Biosciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian, 223003, China
| | - Hafiz M N Iqbal
- School of Engineering and Sciences, Tecnologico de Monterrey, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, 64849, Monterrey, NL, Mexico
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23
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Casaccia M, Fornaro R, Papadia FS, Testa T, Mascherini M, Ibatici A, Ghiggi C, Bregante S, De Cian F. Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy. JSLS 2021; 24:JSLS.2020.00045. [PMID: 33100817 PMCID: PMC7546779 DOI: 10.4293/jsls.2020.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution. Methods A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique. Results SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis. Conclusion SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Francesco Saverio Papadia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
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Lakhotia R, Roschewski M. Circulating tumour DNA in B-cell lymphomas: current state and future prospects. Br J Haematol 2021; 193:867-881. [PMID: 33550600 DOI: 10.1111/bjh.17251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
Circulating tumour DNA (ctDNA) is a highly versatile analyte and an emerging biomarker for detection of tumour-specific sequences in lymphoid malignancies. Since ctDNA is derived from tumour cells throughout the body, it overcomes fundamental limitations of tissue biopsies by capturing the complete molecular profile of tumours, including those from inaccessible anatomic locations. Assays for ctDNA are minimally invasive and serial sampling monitors the effectiveness of therapy and identifies minimal residual disease below the detection limit of standard imaging scans. Dynamic changes in ctDNA levels measure real-time tumour kinetics, and early reductions in ctDNA during treatment correlate with clinical outcomes in multiple B-cell lymphomas. After therapy, ctDNA can effectively discriminate between patients who achieved a complete molecular remission from those with residual treatment-resistant disease. Serial monitoring of ctDNA after therapy can detect early molecular relapse and identify drug-resistant clones that harbour targetable mutations. In order for ctDNA to reach its full potential, the standardization and harmonization of the optimal pre-analytical and analytical techniques for B-cell lymphomas is a critically necessary requirement. Prospective validation of ctDNA within clinical studies is also required to determine its clinical utility as an adjunctive decision-making tool.
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Affiliation(s)
- Rahul Lakhotia
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Grant CN, Aldrink J, Lautz TB, Tracy ET, Rhee DS, Baertschiger RM, Dasgupta R, Ehrlich PF, Rodeberg DA. Lymphadenopathy in children: A streamlined approach for the surgeon - A report from the APSA Cancer Committee. J Pediatr Surg 2021; 56:274-281. [PMID: 33109346 DOI: 10.1016/j.jpedsurg.2020.09.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/19/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Lymphadenopathy is a common complaint in children. Pediatric surgeons are often called upon to evaluate, treat, and/or biopsy enlarged lymph nodes. With many nonsurgical causes in the differential diagnosis, the surgeon plays the important role of providing reassurance and timely diagnosis while minimizing the pain and morbidity associated with surgical interventions in children. The purpose of this summary paper is to provide a management guide for surgeons working up children with lymphadenopathy. MATERIALS/METHODS The English language literature was searched for "lymphadenopathy in children". All manuscript types were considered for review, regardless of medical specialty, with emphasis placed on published guidelines, algorithms, and reviews. After thorough review of these manuscripts and cross-referencing of their bibliographies, the attached algorithm was developed, with emphasis on the role and timing of surgical intervention. RESULTS The APSA Cancer Committee developed the attached algorithm to fill a gap in the surgical literature. It outlines lymphadenopathy workup and treatment with emphasis on the role and timing of surgical intervention. CONCLUSION This review defines and summarizes the common etiologies and presentations of lymphadenopathy in children, and offers a straightforward algorithm for evaluation of and treatment with an emphasis on malignancy risk and surgical management. TYPE OF STUDY Summary paper. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christa N Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Department of Surgery, Milton S. Hershey Medical Center, Hershey, PA.
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI
| | - David A Rodeberg
- Division of Pediatric Surgery, East Carolina Medical Center, Greenville, NC
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Dvorak P, Hoffmann P, Balik M, Hoffmannova M, Kopecky J, Dvorakova R, Nova M. Percutaneous biopsy of retroperitoneal lesions - 10 year experience of a single centre. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:435-443. [DOI: 10.5507/bp.2019.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
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Cohen OC, Brodermann MH, Dervin A, Raja N, Marafioti T, Otero S, Beale T, Jawad S, Ramsay A, Pomplun S, Ardeshna KM, Proctor I, Townsend W, Morley S. Lymph node core biopsies reliably permit diagnosis of lymphoproliferative diseases. Real-World Experience from 554 sequential core biopsies from a single centre. Eur J Haematol 2020; 106:267-272. [PMID: 33159689 DOI: 10.1111/ejh.13545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Whilst excision biopsy is traditionally preferred, advances in radiological and histological techniques warrant a re-look at core biopsy as a viable primary diagnostic method. METHOD Over a 3-year period, all patients who underwent core biopsy to investigate lymphoma at our centre were included. RESULTS 554 consecutive patients were included (40.1% prior lymphoma and 59.4% new presentations). Three or more cores were taken in 420 (75.8%) cases. Median time from request to biopsy and biopsy to histology report was 2 (0-40) days and 7 (1-24) days, respectively. 510/544 (93.8%) biopsies were diagnostic. There was no difference in whether the biopsy was diagnostic based on indication (new vs. relapsed lymphoma) (P = .445), whether biopsy was PET-directed (P = .507), for T-cell lymphoma (P = .468) or nodal vs. extra-nodal (P = .693). Thirty-eight patients (6.9%) required a second biopsy due to inadequate tissue. In a patient experience survey, only 13.9% reported any complications (1 self-limiting minor bleeding, 4 bruising) whilst 16.7% reported any discomfort beyond 12 hours. CONCLUSION Core biopsy performed by experienced radiologists and analysed by expert haemato-pathologists is a reliable, well-tolerated method for diagnosing lymphoma and confirming relapse. Multiple cores can be obtained under local anaesthetic yielding sufficient material in the majority of cases.
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Affiliation(s)
- Oliver C Cohen
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Aoife Dervin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Neel Raja
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Teresa Marafioti
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sofia Otero
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Beale
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Susan Jawad
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alan Ramsay
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Sabine Pomplun
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirit M Ardeshna
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian Proctor
- University College London Hospitals NHS Foundation Trust, London, UK
| | - William Townsend
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Morley
- University College London Hospitals NHS Foundation Trust, London, UK
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Seviar D, Yousuff M, Chia Z, Ramesar K, Newman J, Howlett DC. Image-guided core needle biopsy as the first-line diagnostic approach in lymphoproliferative disorders-A review of the current literature. Eur J Haematol 2020; 106:139-147. [PMID: 33080089 DOI: 10.1111/ejh.13532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022]
Abstract
The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost-effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%-93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well-tolerated and should be considered the first-line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.
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Affiliation(s)
- Dale Seviar
- Department of Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Mehreen Yousuff
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Zoe Chia
- Department of General Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Keith Ramesar
- Department of Histopathology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Joel Newman
- Department of Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - David C Howlett
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
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Casaccia M, Lemoli RM, Angelucci E, Bregante S, Ballerini F, Ibatici A, Ghiggi C, De Cian F. Feasibility of Single-Port Laparoscopic Lymph Node Biopsy for Intra-Abdominal Lymphoma: A Case Series. J Laparoendosc Adv Surg Tech A 2020; 31:458-461. [PMID: 33216698 DOI: 10.1089/lap.2020.0695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Laparoscopic lymph node biopsy through a multi-port access (MPLB) is a well-established technique for intra-abdominal lymphoma diagnosis. The aim of the current study is to assess the feasibility and the diagnostic accuracy of the single-port laparoscopic lymph node biopsy (SPLB) in intra-abdominal lymphoma. Materials and Methods: Between October 2016 and February 2019, 15 patients underwent SPLB to rule out or to follow the progression of a lymphoma. The clinical outcome and the pathology reports were analyzed retrospectively. Results: SPLB was completed laparoscopically in all cases. The total number of biopsies performed for each procedure was sometimes multiple (median: 2; range: 1-3). Duration of surgery was 85 ± 32 minutes (range: 75-105 minutes). Length of hospitalization was 1.8 ± 0.7 days (range: 1-3 days). No major postoperative complications occurred. A cutaneous infection managed conservatively was observed in a patient. In 10 patients, SPLB was used to establish a diagnosis whereas in 5 patients it was performed to follow a progression of a lymphoproliferative disease. In 93.3% of the cases, SPLB achieved the correct diagnosis and subsequent therapeutic decisions. Conclusion: SPLB has shown good procedure and postoperative outcomes as well as a high diagnostic yield, comparable to literature data on traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Roberto Massimo Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Li J, Han J, Wang Y, Mo Y, Li J, Xiang J, Li Z, Zhou J, Wang S. Core Needle Biopsy Targeting the Viable Area of Deep-Sited Dominant Lesion Verified by Color Doppler and/or Contrast-Enhanced Ultrasound Contribute to the Actionable Diagnosis of the Patients Suspicious of Lymphoma. Front Oncol 2020; 10:500153. [PMID: 33117672 PMCID: PMC7577120 DOI: 10.3389/fonc.2020.500153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
Background Inadequate accuracy of ultrasound-guided core needle biopsy (US-CNB) urges further improvement for the diagnosis and management of lymphoma to meet with the practitioners’ increased reliance on this mini-invasive approach. Methods Data related to US-CNB of the deep-sited dominant lesions suspicious of lymphoma detected by computer tomography or positron-emission tomography/computer tomography for eligibility assessment of three prospective clinical trials were collected in advance. A retrospective analysis of the prospective data collection was performed, in which Viable-targeting US-CNB that Color Doppler flow imaging (CDFI) and/or contrast enhanced ultrasound (CEUS) were employed to select viable area for biopsy target compared with Routine US-CNB that routine procedure of evaluation and guidance using gray-scale ultrasound with CDFI in terms of the yield of clinically actionable diagnosis and safety, and determinants for the successful US-CNB that established an actionable diagnosis were explored. The establishment of final diagnosis was based on surgical pathology or medical response to therapy with follow-up at least 6 months. Results A total of 245 patients underwent Routine US-CNB (N = 120) or Viable-targeting US-CNB (N = 125), of which 91 (91/120, 75.8%) and 112 (112/125, 89.6%) were revealed with actionable diagnoses, respectively (p = 0.004, OR 0.846, 95% CI: 0.753–0.952). And 239 patients established final diagnoses. Diagnostic yields of actionable diagnosis according to the final diagnoses were 78.4% (91/116) and 91.1% (112/123) (p = 0.006, OR 0.554, 95% CI: 0.333–0.920), 82.6% (90/109) and 92.5% (111/120) for malignancy, 84.0% (84/100) and 91.8% (101/110) for lymphoma, 85.1% (80/94) and 92.3% (96/104) for Non-Hodgkin Lymphoma, 66.7% (4/6) and 83.3% (5/6) for Hodgkin Lymphoma in Routine and Viable-targeting CNB groups, respectively. No major complications were observed. Dominant lesions with actionable diagnosis in US-CNB were with higher FDG-avid Standardized Uptake Value. Binomial logistic regression revealed that actionable diagnosis of US-CNB was correlated with group and ancillary studies. Conclusion Viable-Targeting US-CNB was superior to routine US-CNB in term of the yield of actionable diagnosis for deep-sited dominant lesions suspicious of lymphoma, which demonstrated a potential to be the initial approach in this setting.
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Affiliation(s)
- Jian Li
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing Han
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunxian Mo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jin Xiang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiming Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhou
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Siyu Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Schmitz C, Rekowski J, Müller SP, Farsijani N, Hertenstein B, Franzius C, von Verschuer U, La Rosée P, Freesmeyer M, Wilop S, Krohn T, Raghavachar A, Ganser A, Bengel FM, Prange-Krex G, Kroschinsky F, Kotzerke J, Giagounidis A, Dührsen U, Hüttmann A. Impact of complete surgical resection on outcome in aggressive non-Hodgkin lymphoma treated with immunochemotherapy. Cancer Med 2020; 9:8386-8396. [PMID: 32926763 PMCID: PMC7666729 DOI: 10.1002/cam4.3448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Surgical resection is considered to be of purely diagnostic value in aggressive lymphoma. Evidence for an impact on outcome is scant and restricted to retrospective observations. Methods In the “Positron Emission Tomography‐guided Therapy of Aggressive non‐Hodgkin Lymphomas” (PETAL) trial, patients with a negative baseline positron emission tomography (PET) scan were documented in a prospective observational substudy. Baseline PET‐negative patients with the absence of lymph node enlargement on computed tomography and a negative bone marrow biopsy were considered to have undergone complete lymphoma resection. Results Eighty‐two of 1,041 patients (7.9%) had a negative baseline PET scan, and 67 were included in this analysis. All were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), plus rituximab for CD20‐positive lymphomas. Among 52 patients with diffuse large B‐cell lymphoma (DLBCL), 48 had completely resected disease. Their outcome tended to be better than that of 115 baseline PET‐positive stage I DLBCL patients treated in the main part of the PETAL trial (2‐year progression‐free survival 92.7% [95% confidence interval 84.7‐100] versus 88.4% [82.5‐94.3], P = .056; 2‐year overall survival 92.7% [84.7‐100] versus 93.7% [89.2‐98.2], P = .176), but this was restricted to patients below the age of 60 years (2‐year progression‐free survival 100% versus 92.2% [84.8‐99.6], P = .031; 2‐year overall survival 100% versus 95.9% [90.2‐100], P = .075). In peripheral T‐cell lymphoma, eight of 11 patients had completely resected disease. In contrast to DLBCL, complete resection was not associated with improved outcome compared to the control. Conclusion Young patients with early stage DLBCL may benefit from complete lymphoma resection prior to immunochemotherapy.
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Affiliation(s)
- Christine Schmitz
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Jan Rekowski
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Stefan P Müller
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Navid Farsijani
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | | | - Christiane Franzius
- Zentrum für moderne Diagnostik (Zemodi), Zentrum für Nuklearmedizin und PET/CT, Bremen, Germany
| | | | - Paul La Rosée
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Stefan Wilop
- Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation, Universitätsklinikum Aachen, Aachen, Germany
| | - Thomas Krohn
- Klinik für Nuklearmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Aruna Raghavachar
- Medizinische Klinik 1, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Arnold Ganser
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Frank M Bengel
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Frank Kroschinsky
- Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Jörg Kotzerke
- Klinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Ulrich Dührsen
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Andreas Hüttmann
- Klinik für Hämatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
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Mantsopoulos K, Koch M, Fauck V, Schinz K, Schapher M, Constantinidis J, Rösler W, Iro H. Primary parotid gland lymphoma: pitfalls in the use of ultrasound imaging by a great pretender. Int J Oral Maxillofac Surg 2020; 50:573-578. [PMID: 32938567 DOI: 10.1016/j.ijom.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/23/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to highlight several misleading imaging and clinical aspects of parotid gland lymphoma, taking our personal experience and relevant literature reports into consideration. The records of all patients diagnosed with lymphoma in the parotid gland between 2005 and 2017 were examined retrospectively. Sixty-seven patients were included in this study. The mean age was 61.4 years. The most frequent histological entities were marginal zone B-cell lymphoma (31.3%) and follicular lymphoma (28.4%). The tumour was stage I in 35 cases (52.2%), stage II in 13 cases (19.4%), stage III in 11 cases (16.4%), and stage IV in eight cases (11.9%). B symptoms were seen in only three patients (4.5%). The diagnosis was made after parotidectomy in 51 cases (76.1%), by core needle biopsy in 14 cases (20.9%), and by means of open biopsy in the remaining two cases (3.0%). Parotid gland lymphoma represents a diagnostically challenging, multifaceted entity that can easily mimic both benign and malignant conditions. This entity should be included in the differential diagnosis of almost all types of parotid lesion, as it seems to play the role of a great pretender.
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Affiliation(s)
- K Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - M Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - V Fauck
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - K Schinz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Schapher
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Constantinidis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Thessaloniki, Greece
| | - W Rösler
- Department of Haematology-Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - H Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Hokland P, Shah M, David K, Evens A, Auer R, Ledieu R, Kreissl S, Bröckelmann PJ, Borchmann P, Korula A, Mathews V, Owattanapanich W, Trotman J. How I treat advanced Hodgkin lymphoma - a global view. Br J Haematol 2020; 190:837-850. [PMID: 32557589 DOI: 10.1111/bjh.16587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Mansi Shah
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Kevin David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Andrew Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rebecca Auer
- Department of Haemato-oncology, Barts Health NHS Trust, London, UK
| | - Rifca Ledieu
- Centre for Haemato-oncology, Barts Cancer Institute, London, UK
| | - Stefanie Kreissl
- German Hodgkin Study Group, Department I of Internal Medicine, Center for Integrated Oncology, University of Cologne, Aachen Bonn Cologne Duesseldorf, Köln, Germany
| | - Paul J Bröckelmann
- German Hodgkin Study Group, Department I of Internal Medicine, Center for Integrated Oncology, University of Cologne, Aachen Bonn Cologne Duesseldorf, Köln, Germany
| | - Peter Borchmann
- German Hodgkin Study Group, Department I of Internal Medicine, Center for Integrated Oncology, University of Cologne, Aachen Bonn Cologne Duesseldorf, Köln, Germany
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
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Broccoli A, Nanni C, Cappelli A, Bacci F, Gasbarrini A, Tabacchi E, Piovani C, Argnani L, Ghermandi R, Sabattini E, Golfieri R, Fanti S, Zinzani PL. Diagnostic accuracy of positron emission tomography/computed tomography-driven biopsy for the diagnosis of lymphoma. Eur J Nucl Med Mol Imaging 2020; 47:3058-3065. [PMID: 32556484 PMCID: PMC7680329 DOI: 10.1007/s00259-020-04913-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Abstract
Introduction Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. Nevertheless, it requires hospitalization, availability of an operating room, and sometimes general anesthesia, and it is associated with several drawbacks. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be potentially used to drive biopsy to the most metabolically active area within a lymph node or extranodal masses. Methods A study of diagnostic accuracy was conducted to assess the performance of a PET-driven needle biopsy in patients with suspect active lymphoma. Results Overall, 99 procedures have been performed: three (3.0%) were interrupted because of pain but were successfully repeated in two cases. Median SUVmax of target lesions was 10.7. In 84/96 cases, the tissue was considered adequate to formulate a diagnosis (diagnostic yield of 87.5%) and to guide the following clinical decision. The target specimen was a lymph node in 60 cases and an extranodal site in 36. No serious adverse events occurred. The sensitivity of this procedure was 96%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 75%. Conclusion Patients can benefit from a minimally invasive procedure which allows a timely and accurate diagnosis of lymphoma at onset or relapse.
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Affiliation(s)
- Alessandro Broccoli
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, Medicina Nucleare Metropolitana, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Alberta Cappelli
- Radiology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
| | - Francesco Bacci
- Haematopathology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
| | - Alessandro Gasbarrini
- Oncological and Degenerative Spine Surgery, Institute of Orthopaedics "Rizzoli", via Pupilli 1, 40136, Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine, Medicina Nucleare Metropolitana, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Carlo Piovani
- Oncological and Degenerative Spine Surgery, Institute of Orthopaedics "Rizzoli", via Pupilli 1, 40136, Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Riccardo Ghermandi
- Oncological and Degenerative Spine Surgery, Institute of Orthopaedics "Rizzoli", via Pupilli 1, 40136, Bologna, Italy
| | - Elena Sabattini
- Haematopathology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Medicina Nucleare Metropolitana, Sant'Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, via Massarenti 9, 40138, Bologna, Italy.
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Zhang ML, Sohani AR. Lymphomas of the Mediastinum and Their Differential Diagnosis. Semin Diagn Pathol 2020; 37:156-165. [PMID: 32451144 DOI: 10.1053/j.semdp.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/01/2020] [Indexed: 12/24/2022]
Abstract
Lymphoma is the most common malignancy involving the mediastinum but can be challenging to diagnose on small biopsy specimens. This review provides a pattern-based approach to help triage small tissue samples for the diagnosis of mediastinal lymphoid proliferations, with focus on the main primary mediastinal lymphomas. The use of ancillary studies is highlighted, along with considerations to avoid misdiagnosis and scenarios to request additional tissue.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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Image-guided core needle biopsy in the diagnosis of malignant lymphoma: comparison with surgical excision biopsy. Eur J Radiol 2020; 127:108990. [PMID: 32304929 DOI: 10.1016/j.ejrad.2020.108990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This study aimed to compare the efficacy and safety of image-guided core needle biopsy (CNB) with those of surgical excision biopsy (SEB) for the diagnosis of lymphoma, and to clarify the indication of CNB in clinical practice. METHOD This retrospective study included 263 image-guided CNB cases and 108 SEB cases that were performed at our institution between January 2014 and December 2018. The rate of patients with performance status of grade 1-4 was higher in the CNB group than in the SEB group (43.7% vs. 24.1%, P < 0.01). Waiting time to biopsy and diagnosis was shorter for CNB group than for SEB group (4 days vs. 7 days, 13 days vs. 15 days, P < 0.01). The rate of biopsy at the deep sites was higher in the CNB group than in the SEB group (53.2% vs. 8.3%, P < 0.01). Successful biopsy and complication rates were compared between the 2 groups. RESULTS There were no significant differences between the CNB and SEB groups in successful biopsy rates (89.0% vs. 93.5%, P = 0.25). The grade 3 complication rate was significantly lower for CNB group than for SEB group (0% vs. 4.6%, P < 0.01), although there was no significant difference in overall complication rates (4.9% vs. 6.5%, respectively, P = 0.61). CONCLUSIONS CNB showed high diagnostic yield comparable to SEB for suspected lymphoma. CNB was especially recommended to the cases with low-PS, lesions in the deep sites, and requiring early pathological diagnosis.
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Fratoni S, Zanelli M, Zizzo M, Sanguedolce F, Aimola V, Cerrone G, Ricci L, Filosa A, Martino G, Fara AM, Annessi V, Soriano A, Ascani S. The broad landscape of follicular lymphoma: Part II. Pathologica 2020; 112:79-92. [PMID: 32202535 PMCID: PMC7931560 DOI: 10.32074/1591-951x-6-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/15/2022] Open
Abstract
Follicular lymphoma is a neoplasm derived from follicle center B cells, typically both centrocytes and centroblasts, in variable proportions according to the lymphoma grading. The pattern of growth may be entirely follicular, follicular and diffuse and rarely completely diffuse. It represents the second most common non-Hodgkin lymphoma, after diffuse large B-cell lymphoma and it is the most common low-grade mature B-cell lymphoma in Western countries. In the majority of cases, follicular lymphoma is a nodal tumor, occurring in adults and is frequently associated with the translocation t(14;18)(q32;q21)/IGH-BCL2. However, in recent years the spectrum of follicular lymphoma has expanded and small subsets of follicular lymphoma, which differ from common follicular lymphoma, have been identified and included in the current 2017 WHO classification. The aim of our review is to describe the broad spectrum of follicular lymphoma, pointing out that the identification of distinct clinicopathological variants of follicular lymphoma is relevant for the patient outcomes and treatment.
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Affiliation(s)
- Stefano Fratoni
- Department of Anatomic Pathology, St. Eugenio Hospital of Rome, Rome, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | | | | | - Linda Ricci
- Pathology Unit, University of Siena, Siena, Italy
| | | | - Giovanni Martino
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy
| | - Antonella Maria Fara
- Pathology Unit, Department of Medical, Surgical and Experimental Surgery, University of Sassari, Italy
| | - Valerio Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Guastalla, Reggio Emilia, Italy
| | - Alessandra Soriano
- Gastroenterology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria Terni, University of Perugia, Terni, Italy
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Assaf N, Nassif S, Tamim H, Bazarbachi A, Zaatari G, Chakhachiro Z. Diagnosing Lymphoproliferative Disorders Using Core Needle Biopsy Versus Surgical Excisional Biopsy: Three-Year Experience of a Reference Center in Lebanon. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e455-e460. [PMID: 32461041 DOI: 10.1016/j.clml.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite current guidelines, a significant increase in the use of core needle biopsy (CNB) has been noted. Our aims were to determine the profile of patients referred for image-guided biopsies, to assess the diagnostic yield of these biopsies, and to learn whether CNB is an effective alternative to surgical excisional biopsy (SEB). PATIENTS AND METHODS All lymph node biopsy samples evaluated in the Department of Pathology and Laboratory Medicine from 2014 to 2017 were included. Patients' demographics, biopsy type, and final diagnosis were recorded and classified as diagnostic or nondiagnostic. The reasons for the latter were evaluated and follow-up was obtained, where available. RESULTS A total of 373 cases, 210 CNB and 163 SEB, were collected. The diagnostic yield was 79% for CNB compared to 97% for SEB. The choice of CNB versus SEB was not dependent on patient's age, gender, or clinical suspicion of malignancy. Failure to reach a diagnosis was due to insufficient or suboptimal tissue in most nondiagnostic CNBs. Lymphoma was equally diagnosed among CNB and SEB. CNB was at an advantage in diagnosing large B-cell lymphomas. CONCLUSION When performed adequately, CNB is a good substitute for SEB. Strict and specific guidelines need to be updated and adopted to indicate how and when it can be used, including the recommendation of concomitant complementary diagnostic laboratory testing such as flow cytometry. The latter should be readily available in order to not compromise the quality and accuracy of the diagnoses.
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Affiliation(s)
- Nada Assaf
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zaher Chakhachiro
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Cytology Versus Histology in the Primary Diagnosis of Lymphoma Located in the Mediastinum. Ann Thorac Surg 2019; 108:244-248. [DOI: 10.1016/j.athoracsur.2019.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 12/23/2022]
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40
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Campanelli M, Cabry F, Marasca R, Gelmini R. Peripheral lymphadenopathy: role of excisional biopsy in differential diagnosis based on a five-year experience. MINERVA CHIR 2019; 74:218-223. [DOI: 10.23736/s0026-4733.18.07752-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaur A, Rayatt S, Jagadeesan J, Hejmadi R, Singh S. Metastatic melanoma vs lymphoma. Using a sentinel lymph node biopsy a diagnostic tool. J Surg Case Rep 2019; 2019:rjz117. [PMID: 30997016 PMCID: PMC6460898 DOI: 10.1093/jscr/rjz117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a prognostic tool used in cases of melanoma with a stage IB or greater and the absence of clinical lymphadenopathy. A positive SLNB historically indicated a need for regional lymph node clearance. However, cases of clinical lymphadenopathy in the presence of primary melanoma negates the use of SLNB and rather the British Association of Dermatologists advocate a primary block dissection of regional lymphatic tissue [NICE UK. Melanoma: assessment and management. NICE Guideline NG 14. 2015]. The following describes the case of a patient with an original stage II melanoma and a concurrent diagnosis of B cell lymphoma associated with widespread lymphadenopathy. Our multi-disciplinary team believe the use of SLNB is a more informative investigation compared with ultrasonograpphy and fine needle aspiration for such cases. In cases of clinical uncertainty due to a dual diagnosis of lymphoma, cytology would not provide nodal morphology or histological architecture, required for lymphoma grade and subtype.
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Affiliation(s)
- Anjana Kaur
- Plastic Surgery Department, Ninewells Hospital, NHS Tayside, James Arrott Drive, Dundee, Scotland DD2 1UB, UK
| | - Sukh Rayatt
- Plastic Surgery Department, Queen Elizabeth Hospital of Birmingham, Mindelsohn Way, Birmingham, West Midlands B15 2TH, UK
| | - Jagjeevan Jagadeesan
- Plastic Surgery Department, Queen Elizabeth Hospital of Birmingham, Mindelsohn Way, Birmingham, West Midlands B15 2TH, UK
| | - Rahul Hejmadi
- Plastic Surgery Department, Queen Elizabeth Hospital of Birmingham, Mindelsohn Way, Birmingham, West Midlands B15 2TH, UK
| | - Shivram Singh
- Plastic Surgery Department, Queen Elizabeth Hospital of Birmingham, Mindelsohn Way, Birmingham, West Midlands B15 2TH, UK
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42
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Jelloul FZ, Navarro M, Navale P, Hagan T, Cocker RS, Das K, Rosen L, Zhang X, Sheikh-Fayyaz S. Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience. Acta Cytol 2019; 63:198-205. [PMID: 30909285 DOI: 10.1159/000497252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/26/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective is to study the efficacy of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) in the diagnosis of lymphoma in a single institution. STUDY DESIGN We retrospectively reviewed 635 FNAB/CNB cases performed in our institution to rule out lymphoma during a 4-year period and collected the relevant clinical and pathological information for statistical analysis. RESULTS AND CONCLUSIONS This cohort comprised 275 males and 360 females, with a median age of 57 years. Among the 593 cases with adequate diagnostic materials for lymphoma work-up, 226 were positive for lymphoma, 286 were negative for lymphoma, and 81 were nondiagnostic. Each case had an FNAB, and 191 cases also underwent a CNB. The subclassification rate according to the WHO (2008) was 67% overall, 81% for the FNAB with CNB group, and 40% for the FNAB group. In the FNAB with CNB group, the subclassification rates for cases with and without a history of lymphoma were not significantly different. A definitive diagnosis of lymphoma relied on ancillary studies, but was not affected by location, or the needle gauge of CNB. Follow-up data revealed a high diagnostic accuracy of FNAB with CNB. In conclusion, the use of FNAB and CNB with ancillary studies is effective in providing a definitive diagnosis of lymphoma in our experience at the Northwell Health System.
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Affiliation(s)
- Fatima-Zahra Jelloul
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Maria Navarro
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Pooja Navale
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Tamla Hagan
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Rubina S Cocker
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Lisa Rosen
- The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Xinmin Zhang
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Silvat Sheikh-Fayyaz
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA,
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Drylewicz MR, Watkins MP, Shetty AS, Lin MF, Salter A, Bartlett NL, Middleton WD, Yano M. Formulating a Treatment Plan in Suspected Lymphoma: Ultrasound-Guided Core Needle Biopsy Versus Core Needle Biopsy and Fine-Needle Aspiration of Peripheral Lymph Nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:581-586. [PMID: 30043431 DOI: 10.1002/jum.14724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Image-guided tissue sampling in the workup of suspected lymphoma can be performed by core needle biopsy (CNB) or CNB with fine-needle aspiration (FNA). We compared the yield of clinically actionable diagnoses between these methods of tissue sampling. METHODS All ultrasound-guided percutaneous peripheral lymph node biopsies from 2010 to 2017 at a single institution were retrospectively reviewed for biopsy type (CNB versus CNB + FNA), prior diagnosis of lymphoma, size of the target lymph node, number of cores, length of core specimens, and pathologic diagnosis. Lymphoma and lymphoid tissue were included; metastatic disease and nonlymphoid tissue were excluded. An oncologist specializing in lymphoma independently determined whether an actionable diagnosis could be made with the pathologic results in the context of the patient's medical record. χ2 analyses and univariable/multivariable logistic regression models were used for statistical analyses. RESULTS Of 578 lymph node biopsies, 306 (53%) had a prior diagnosis of lymphoma; 273 (47%) were CNB, and 305 (53%) were CNB + FNA. There was no significant difference between biopsy types (CNB versus CNB + FNA) in the number of cores (median [25th, 75th percentiles], 3 [3, 4] versus 4 [3, 4]; P = .47) or total length of tissue (4.1 [2.5, 6.1] versus 3.7 [2.3, 6] cm; P = .09). There was no difference in obtaining an actionable diagnosis between biopsy types after controlling for a known history of lymphoma (P = .271) or after controlling for the number of core specimens (P = .826). CONCLUSIONS In cases of suspected lymphoma, CNB without FNA was sufficient to obtain an actionable diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Motoyo Yano
- Washington University, St Louis, Missouri, USA
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Mesa H, Rawal A, Gupta P. Diagnosis of Lymphoid Lesions in Limited Samples: A Guide for the General Surgical Pathologist, Cytopathologist, and Cytotechnologist. Am J Clin Pathol 2018; 150:471-484. [PMID: 30084952 DOI: 10.1093/ajcp/aqy077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Advances in interventional techniques allow obtaining samples from most body sites through minimally invasive procedures that yield limited samples. We provide practical guidelines for diagnosis of lymphoid lesions in these samples. METHODS Guidelines for selection of biopsy site and triage of the specimen according to results of rapid on-site evaluation (ROSE), and description of the advantages and limitations of currently available ancillary studies are described, based on the experience of the authors, complemented by a comprehensive review of the literature. RESULTS Five diagnostic categories are observed at ROSE: (1) preponderance of small cells, (2) large cells, (3) mixed small and large cells, (4) blast-like cells, and (5) rare large pleomorphic cells. Detailed description of the diagnostic work-up and subsequent classification for each of these groups is provided. CONCLUSIONS A definitive diagnosis of lymphoid neoplasms in limited samples is possible in most cases through correlation of morphology, ancillary studies, and clinical scenario.
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Affiliation(s)
- Hector Mesa
- Department of Pathology, Veterans Administration Health Care Service, Minneapolis, MN
| | - Ajay Rawal
- Department of Pathology, Methodist Hospital, St Louis Park, MN
| | - Pankaj Gupta
- Department of Hematology Oncology, Veterans Administration Health Care Service, Minneapolis, MN
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45
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Choi SM, Betz BL, Perry AM. Follicular Lymphoma Diagnostic Caveats and Updates. Arch Pathol Lab Med 2018; 142:1330-1340. [PMID: 30221980 DOI: 10.5858/arpa.2018-0217-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular lymphoma is a common small B-cell lymphoma, likely to be encountered by any practicing pathologist, regardless of specialty. Although the features of typical follicular lymphoma are well known and in most instances easily identifiable, there are lesser-appreciated morphologic appearances that can raise alternative diagnostic possibilities. The limited tissue available in core needle biopsies can make it additionally challenging to thoroughly evaluate those features in the context of architecture. Furthermore, ancillary testing including immunohistochemistry and molecular/genetic analysis do not always show classic findings and may pose additional challenges to interpretation. OBJECTIVES.— To review the morphologic features of follicular lymphoma with a discussion of morphologic variants and mimics; to discuss pitfalls of ancillary testing and provide the practicing pathologist with an appropriate context for interpretation of immunohistochemical and molecular/genetic studies when follicular lymphoma is part of the differential diagnosis; and to propose diagnostic strategies when there is limited tissue for evaluation. DATA SOURCES.— We used examples of follicular lymphoma from our institution as well as a review of the literature, with a focus on the diagnostic aspects that are broadly relevant to a general pathology practice. CONCLUSIONS.— Follicular lymphoma can occasionally present with atypical morphologic, immunohistochemical, or molecular/genetic features. In particular, those findings can be difficult to interpret in the setting of a limited tissue sample. Awareness of those possibilities will help guide the pathologist to a more accurate and precise diagnosis.
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Affiliation(s)
- Sarah M Choi
- From the Department of Pathology, University of Michigan, Ann Arbor
| | - Bryan L Betz
- From the Department of Pathology, University of Michigan, Ann Arbor
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Paul U, Richter J, Stuhlmann-Laiesz C, Kreuz M, Nagel I, Horn H, Staiger AM, Aukema SM, Hummel M, Ott G, Spang R, Rosenwald A, Feller AC, Cogliatti S, Stein H, Hansmann ML, Moller P, Szczepanowski M, Burkhardt B, Pfreundschuh M, Schmitz N, Loeffler M, Trümper L, Siebert R, Klapper W. Advanced patient age at diagnosis of diffuse large B-cell lymphoma is associated with molecular characteristics including ABC-subtype and high expression of MYC. Leuk Lymphoma 2017; 59:1213-1221. [PMID: 28838257 DOI: 10.1080/10428194.2017.1365851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The incidence of diffuse large B-cell lymphoma (DLBCL) increases with age being patient age at diagnosis an adverse prognostic factor. However, elderly patients are often underrepresented in common studies. To investigate the effect between age and biological characteristics in DLBCL, we analyzed data of 1534 patients encompassing all adult age groups, enriched for the age ≥75 years. Follicular lymphoma (FL) grade 3B with histopathological characteristics of DLBCLs were included. Gender, centroblastic cytology, FL grade 3B morphology, CD10 expression, and ABC/non-GCB-subtype were significantly associated with age after correction for multiple testing and after adjusting for cohorts. Analysis of a subgroup points towards an association of MYC expression with age. Our data indicate that biological features of DLBCL and FL grade 3B are associated with increasing age among adult patients. The prevalence of the ABC/non-GCB-subtype in elderly patients suggests that therapies targeting this molecular subtype should be specifically explored in this subgroup.
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Affiliation(s)
- Ulrike Paul
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | - Julia Richter
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | | | - Markus Kreuz
- c Institute for Medical Informatics , Statistics and Epidemiology University of Leipzig , Leipzig , Germany
| | - Inga Nagel
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,d Institute of Pharmacology , Christian-Albrecht University , Kiel , Germany
| | - Heike Horn
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Annette M Staiger
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Sietse M Aukema
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | - Michael Hummel
- g Institute of Pathology, Campus Benjamin Franklin , Charité Universitätsmedizin , Berlin , Germany
| | - German Ott
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Rainer Spang
- h Institute of Functional Genomics , University of Regensburg , Regensburg , Germany
| | - Andreas Rosenwald
- i Institute of Pathology , University Würzburg and Comprehensive Cancer Mainfranken , Würzburg , Germany
| | | | - Sergio Cogliatti
- k Institute of Pathology , Kantonal Hospital St Gallen , St Gallen , Switzerland
| | | | - Martin-Leo Hansmann
- m Institute of Pathology , University Hospital Frankfurt , Frankfurt , Germany
| | - Peter Moller
- n Institute of Pathology , University Medical Center Ulm , Ulm , Germany
| | - Monika Szczepanowski
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany.,o Department of Internal Medicine II, Hematology Laboratory , Christian-Albrecht University , Kiel , Germany
| | - Birgit Burkhardt
- p Department of Pediatric Hematology and Oncology , NHL-BFM Study Center, University Children's Hospital , Münster , Germany
| | - Michael Pfreundschuh
- q Medizinische Klinik I , Saarland University Medical School , Homburg/Saar , Germany
| | - Norbert Schmitz
- r Department of Hematology , Asklepios Klinik St. Georg , Hamburg , Germany
| | - Markus Loeffler
- c Institute for Medical Informatics , Statistics and Epidemiology University of Leipzig , Leipzig , Germany
| | - Lorenz Trümper
- s Department of Hematology and Oncology , Georg-August University , Göttingen , Germany
| | - Reiner Siebert
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,t Institute of Human Genetics , University Medical Center Ulm & University Ulm , Ulm , Germany
| | - Wolfram Klapper
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
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[Recovery of paraffin blocks and central archiving : Experiences of the Kiel lymph node registry and the German study group for Hodgkin lymphoma]. DER PATHOLOGE 2017; 38:529-534. [PMID: 28676898 DOI: 10.1007/s00292-017-0321-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Central collection of tissue blocks for pathological and translational research is particularly important in rare diseases. Transfer of tissue blocks from primary to central pathology is of crucial importance. OBJECTIVES We aimed to answer the following questions: Has the transfer of tissue blocks sent for consultation or within clinical trials changed over the last 20 years? What are the reasons for reclaiming tissue blocks by the primary pathology and what actions would convince primary pathologists to leave the blocks in the reference pathology? MATERIAL AND METHODS The first 100 biopsies of each year between 1995 and 2015 (n = 2100), as well as all tissue transfers within therapeutic studies (n = 1405, German Hodgkin Study Group, GHSG) between 1998 and 2015, were analyzed separately for block reclaims using the Department of Pathology database. A questionnaire evaluated the reasons for block reclaiming by the peripheral pathologists. RESULTS There is a significant increase in block reclaims during the period analyzed among submissions for consultation as well as in clinical trials (linear regression, p = 0.0195 and p = 0.0107). The percentage of block reclaims does not differ between consultations and cases submitted upon request within clinical trials (p = 0.2404, t-test). A survey among pathologies that reclaim the block showed that their willingness to leave the block at the reference center would increase if the compatibility with accreditation guidelines (39.3%), a positive statement from professional associations (25%), or a formal confirmation of availability (53.6%) is provided. DISCUSSION In particular, to improve research on rare diseases, it is desirable to point out the compatibility of central archiving in a designated center with accreditation guidelines.
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Pugliese N, Di Perna M, Cozzolino I, Ciancia G, Pettinato G, Zeppa P, Varone V, Masone S, Cerchione C, Della Pepa R, Simeone L, Giordano C, Martinelli V, Salvatore C, Pane F, Picardi M. Randomized comparison of power Doppler ultrasonography-guided core-needle biopsy with open surgical biopsy for the characterization of lymphadenopathies in patients with suspected lymphoma. Ann Hematol 2017; 96:627-637. [PMID: 28130574 PMCID: PMC5334396 DOI: 10.1007/s00277-017-2926-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
Abstract
The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. We employed power Doppler ultrasonography (PDUS) to select the lymph node most suspected of malignancy and to histologically characterize it through the use of large cutting needle. Institutional review board approval and informed consent were obtained for this randomized clinical trial. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either standard surgery or PDUS-guided 16-gauge modified Menghini needle. The primary endpoint was the superiority of sensitivity for the diagnosis of malignancy for core-needle cutting biopsy (CNCB). Secondary endpoints were times to biopsy, complications, and costs. A total of 376 patients were randomized into the two arms and received allocated biopsy. However, four patients undergoing CNCB were excluded for inadequate samples; thus, 372 patients were analyzed. Sensitivity for the detection of malignancy was significantly better for PDUS-guided CNCB [98.8%; 95% confidence interval (CI), 95.9–99.9] than standard biopsy (88.7%; 95% CI, 82.9–93; P < 0.001). For all secondary endpoints, the comparison was significantly disadvantageous for conventional approach. In particular, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with CNCB. The presence of satellite enlarged reactive and/or necrotic lymph nodes may impair the success of an open surgical biopsy (OSB). PDUS and CNCB with adequate gauge are diagnostic tools that enable effective, safe, fast, and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention.
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Affiliation(s)
- Novella Pugliese
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - M Di Perna
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - I Cozzolino
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - G Ciancia
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - G Pettinato
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - P Zeppa
- Department of Medicine and Surgery, University Medical School, Salerno, Salerno, Italy
| | - V Varone
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - S Masone
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Cerchione
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - R Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - L Simeone
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Giordano
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - V Martinelli
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Salvatore
- Department of Economics, University of Molise, Campobasso, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - M Picardi
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
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