Core needle biopsy is a safe and accurate initial diagnostic procedure for suspected lymphoma

Pathologic Validation of Deauville Score-Based Disease on F-18 FDG PET/CT after First-Line Treatment in Patients with Lymphoma

Purpose

PET/CT-based Deauville scoring (DS) is routinely used for lymphoma response assessment. However, pathological correlation of DS is not yet precisely documented. In the present study we aimed to pathological confirm the PET/CT-based Deauville scoring (DS) in lymphoma after first-line chemotherapy.

Materials and methods

Participants undergoing PET/CT for response assessment following first-line treatment were recruited prospectively. DS ≥ 4 lesions were interpreted as PET-positive, while DS ≤ 3 as PET-negative. Participants with a PET-positive lesion or suspicious of inadequate response (DS ≤ 3) were recruited for metabolic core-needle biopsy. True-negative and benign histopathology were kept on follow-up for three months. Histopathological, clinical and imaging findings were assessed for diagnostic performance. Procedure-related complications were also noted.

Results

In all, 148/480 participants were PET-positive, and 332/480 were PET-negative. 138/148 PET-positive and 12/332 PET-negative lesions were recruited for biopsy. Biopsy was performed in 147/150 participants (PET-positive 135; PET-negative 12). Three patients with inaccessible lesions were excluded. The diagnostic yield of the procedure was 97.3% (143/147). Histology revealed lymphoma in 106 participants (including 70% of total DS-4, 100% of DS-5a and 73.9% of DS-5b lesions), with three false-negative lesions. DS ≤ 3 lesions were true-negative except one diagnosed with lymphoma (8.3%) on follow-up. Non-lymphomatous malignancies (n = 5), granulomas (n = 12), non-specific inflammation (n = 9) and no residual disease (n = 11) were diagnosed in the rest. No major procedure-related adverse event was noted.

Conclusion

A DS-5a lesion suggests residual disease; hence, a biopsy can be prevented unless Richter's transformation is suspected. DS-4 and DS-5b lesions require a biopsy before changing the treatment plan, as a certain number of participants had non-lymphomatous F-18 FDG-avid lesions.

The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: systematic review and meta-analysis

OBJECTIVE

This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC).

METHODS

The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491).

RESULTS

In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87‒0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98‒1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84‒0.91; p = 0.12) vs. 0.73 (95% CI 0.69‒0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99‒1.00; p = 1.00) vs. 0.99 (95% CI 0.67‒0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures.

CONCLUSION

US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.

Core Needle Biopsy in Lymphoma Diagnosis: The Diagnostic Performance and the Role of the Multidisciplinary Approach in the Optimization of Results

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.

Lymph node excisions provide more precise lymphoma diagnoses than core biopsies: a French Lymphopath network survey

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.

Global Cytopathology-Hematopathology Practice Trends

OBJECTIVES

Small-volume biopsy-fine-needle aspiration biopsy (FNAB) with or without core biopsy-is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out.

METHODS

This study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated.

RESULTS

Most respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma.

CONCLUSIONS

This survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.

Synchronous early-stage breast cancer and axillary follicular lymphoma diagnosed by core needle biopsy: A case report

Synchronous double cancers are an infrequent finding. The focus of this study was a case of diagnosed synchronous double breast cancer (BC) and axillary (Ax) follicular lymphoma (FL). The patient was a 73-year-old woman who had been visiting her local doctor for follow-up of a fibroadenoma of the left breast, and was referred to our hospital after being diagnosed with invasive ductal carcinoma (IDC) of the left breast. Ultrasonography (US) revealed enlarged Ax lymph nodes (LNs) and US-guided core needle biopsy (CNB) was performed. CNB revealed no metastasis of IDC; however, a diagnosis of FL was made. Therefore, the patient was diagnosed with synchronous double BC and Ax FL and underwent partial surgical resection of the BC and close monitoring of the FL. To the best of our knowledge, this is the first case of malignant lymphoma diagnosed by CNB of Ax LNs during preoperative BC screening. CNB allows for a shorter waiting time for the examination, and it is considered to be minimally invasive, cost-effective and non-inferior to surgical resection in terms of specimen volume. Therefore, active preoperative evaluation of Ax LNs using US-guided CNB may contribute to BC staging, and may also help diagnose synchronous cancers.

Role of Flow Cytometric Immunophenotyping for Classic Hodgkin Lymphoma in Small Biopsy and Cytology Specimens

CONTEXT.—

The diagnosis of classic Hodgkin lymphoma (CHL) traditionally requires surgical tissue biopsy because of the paucity of diagnostic Hodgkin and Reed-Sternberg cells. Diagnosis can be challenging in small core needle and cytologic biopsies, which are increasingly used because of reduced costs and minimal invasiveness. Flow cytometric (FC) identification of Hodgkin and Reed-Sternberg cells is possible, but FC test efficacy is not well studied outside of validation settings, especially in small specimens.

OBJECTIVE.—

To assess the testing efficacy of FC performed on small biopsy and cytology specimens for the diagnosis of CHL.

DESIGN.—

We reviewed 131 patients with CHL and 459 patients without CHL during a 3-year period who underwent a small biopsy procedure, including core biopsy and/or cytology evaluation, with concurrent routine clinical FC testing for CHL, assessing performance of FC in small specimens.

RESULTS.—

Evaluating testing efficacy, sensitivity was 95.4% and specificity was 98.2%, whereas positive and negative predictive values were 92.2% and 99.0%, respectively. Although there were more false-positive results than compared with published validation studies, expert review identified distinct diagnostic pitfalls; awareness of these may improve testing efficacy.

CONCLUSIONS.—

Although FC diagnosis of CHL was historically considered unfeasible, our findings in a real-world clinical setting suggest that FC adds diagnostic value to small biopsy evaluation, reducing time to treatment, costs, and invasive excisional procedures.

Primary lymphoma of the entire esophagus diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)

Primary esophageal lymphoma is extremely rare, with fewer than 30 cases reported in the literature. Presentation is nonspecific with multiple radiological and endoscopic appearances, posing its diagnosis a challenge. We report a case of a primary esophageal lymphoma diagnosed by endoscopic ultrasound-fine needle aspiration in a 68-year-old woman referred to our hospital for evaluation of a submucosal tumor spreading all over the esophageal wall. We describe its clinical and imaging features and stand out the importance of having a specific preoperatory diagnosis in order to avoid a major surgery.

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

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.

Diagnostic accuracy of positron emission tomography/computed tomography-driven biopsy for the diagnosis of lymphoma

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.

Value of CT-guided percutaneous needle biopsy of bone in the diagnosis of lymphomas based on PET/CT results

Background

To evaluate the value of CT-guided percutaneous needle biopsy of bone in the diagnosis of lymphomas based on PET/CT results.

Methods

A retrospective analysis of the records of all patients with percutaneous bone biopsies based on PET/CT results and a final diagnosis of lymphoma between January 2012 and August 2017 was performed. Thirty-one patients were included in this study. The success and complication rates were assessed.

Results

The mean age of the 31 patients was 46.6 ± 21.2 years, and there were 16 men and 15 women. A definite diagnosis and accurate histological subtype were obtained in 26 patients, for a success rate of 84%. The most common subtype was diffuse large B cell lymphoma (n = 18). The remaining subtypes included three cases of marginal-zone lymphoma, two cases of follicular lymphoma, one case of Hodgkin’s lymphoma, one case of peripheral T cell lymphoma, and one case of B cell lymphoblastic lymphoma. No serious complications occurred in any of the patients.

Conclusions

CT-guided needle biopsy based on PET/CT results is a reliable means of diagnosing and classifying lymphomas.

Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience

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.

Formulating a Treatment Plan in Suspected Lymphoma: Ultrasound-Guided Core Needle Biopsy Versus Core Needle Biopsy and Fine-Needle Aspiration of Peripheral Lymph Nodes

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.

Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures

OBJECTIVE

To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents.

METHODS

A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56).

RESULTS

The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001).

CONCLUSION

Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease.

Using Simulation to Help Specify Design Parameters for Vacuum-Assisted Needle Biopsy Systems

Needle biopsy is a routine medical procedure for examining tissue or biofluids for the presence of disease using standard methods of pathology. The finite element analysis (FEA) methodology can provide guidance for optimizing the geometric parameters. The needle biopsy is simulated and analyzed while varying the needle angle, the aperture size and the slice-push ratio k. The results indicate that tissue reaction force in the axial direction of needle gradually decreases, and the stress and strain are more concentrated at the tip of needle with the increases of tip angle; the tissue reaction force decreases, and the torque increases while the slice-push ratio increases; and higher slice–push ratio can increase the peak stress concentration on the cutting edge and deformation of tissue; in the process of core needle cutting, increasing slice–push ratio can reduce the tissue reaction force significantly. While the aperture on distal wall of outer cannula becomes wider, the tissue reaction force increases significantly, and the cutting process will be more unstable. The results have the potential to provide important insight for improving the needle biopsy design process.

Image-guided fine-needle aspiration cytology and flow cytometry phenotyping of neck lymphadenopathy for the diagnosis of recurrent lymphoma

OBJECTIVE

In patients with a history of lymphoma, each lymphadenopathy should be carefully evaluated. The aims of this study were to evaluate (i) the usefulness of high-resolution ultrasonography (US), US-guided fine-needle aspiration cytology (FNAC) and flow cytometry phenotyping (FCP) together in the diagnosis of recurrent lymphoma and (ii) whether these tools were independent predictors of correct results.

DESIGN

Retrospective cohort study with stepwise forward logistic regression analysis of results.

SETTING

Tertiary referral centre.

PARTICIPANTS

A total of 151 patients with a history of lymphoma who developed a cervical mass during follow-up.

METHODS

On neck US, a lymphadenopathy was shown in 129 (85.4%) patients (median age 57 years, range 18-78 years), and US-guided FNAC combined with FCP were immediately performed. All patients had surgical excision and subsequent histological examination of the enlarged node(s), to establish lymphoma subclassification.

RESULTS

Final histology confirmed recurrence in 82 (63.6%) patients. According to the logistic regression analysis, FNAC and FCP were independent predictors of correct results (P = 0.009 and 0.028, respectively) and did not interfere with each other. The sensitivity, specificity and accuracy of the combination of all of the tools were 98.8%, 100% and 99.2%, respectively, and the area under the receiver operating characteristic curve was 0.902 (95% CI: 0.797-0.986).

CONCLUSION

This minimally invasive procedure is easily performed and should be recommended for all patients with cervical lymphadenopathy and a history of lymphoma, avoiding the need of core-biopsy or surgical excision if recurrence was excluded.

Sensitivity of fine-needle aspiration biopsy for diagnosing and grading follicular lymphomas using a multiparameter approach in a cancer center

OBJECTIVES

The diagnosis and grading of follicular lymphomas (FLs) by fine-needle aspiration biopsy (FNAB) has not been systematically compared with core needle biopsy (CNB). We evaluated the sensitivity of FNAB in diagnosing and grading FLs using a multiparameter approach in a large cancer center.

METHODS

We retrospectively identified CNBs of lymph nodes diagnosed as FL that also had a concurrently acquired FNAB on the same site. The majority of cases had flow cytometric analysis and these results were available for interpretation of both the FNAB and CNB.

RESULTS

Out of 342 patients, CNB diagnoses included 291 (85%) low-grade (LG) FLs, 30 (9%) high-grade (HG) FLs, and 21 (6%) non-graded FLs/other. FNAB diagnoses included 194 (57%) LG FLs, 19 (6%) HG FLs, 93 (27%) non-graded FLs, 9 (3%) large B-cell lymphomas (LBCL) of follicle center origin, and 27 (7%) insufficient for diagnosis/other. Review of non-graded FLs showed 45% LG, 35% indeterminate due to polymorphous lymphoid cells with increased numbers of large cells, and 20% scant cellularity. Sensitivity of FNAB for diagnosing FL was 89%, and 66% for LG FL. The latter increased (94%), however, when grading was performed.

CONCLUSION

FNAB is highly sensitive for diagnosing FLs when cellular material for cytomorphology and flow cytometric analysis is obtained, and grading is feasible for most LG FLs. A subset of FLs composed of a polymorphous lymphoid population with increased numbers of large cells may be more difficult to grade, and HG FLs can be difficult to distinguish from CD10-positive diffuse LBCLs.

Core needle biopsies and surgical excision biopsies in the diagnosis of lymphoma-experience at the Lymph Node Registry Kiel

Current guidelines of the European Society of Medical Oncology recommend surgical excision biopsies of lymph nodes for the diagnosis of lymphoma whenever possible. However, core needle biopsies are increasingly used. We aimed to understand the common practice to choose the method of biopsy in Germany. Furthermore, we wanted to understand performance of surgical excision and core needle biopsies of lymph nodes in the diagnosis of lymphoma. The files of 1510 unselected, consecutive lymph node specimens from a consultation center for lymphoma diagnosis were analyzed. Core needle biopsies were obtained frequently from lymph nodes localized in mediastinal, abdominal, retroperitoneal, or thoracic regions. Patients undergoing core needle biopsies were significantly older and suffered significantly more often from lymphoma than patients undergoing surgical excision biopsies. Although more immunohistochemical tests were ordered by the pathologist for core needle biopsies specimens than for surgical excision biopsies specimens, core needle biopsies did not yield a definite diagnosis in 8.3 % of cases, compared to 2.8 % for SEB (p = 0.0003). Restricting the analysis to cases with a final diagnosis of follicular lymphoma or diffuse large B-cell lymphoma, core needle biopsies identified a simultaneous low- and high-grade lymphoma (transformation) in 3.3 % of cases, compared to 7.6 % for surgical excision biopsies (p = 0.2317). In Germany, core needle biopsies are preferentially used in elderly patients with a high likelihood of suffering from lymphoma. Core needle appeared inferior to surgical excision biopsies at providing a definite diagnosis and at identifying multiple lymphoma differentiations and transformation.