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Kumar R, Krishnaraju VS, Mittal BR, Shankar K, Singh H, Ramachandran A, Bhattacharya A, Prakash G, Bal A, Malhotra P. Pathologic Validation of Deauville Score-Based Disease on F-18 FDG PET/CT after First-Line Treatment in Patients with Lymphoma. Nucl Med Mol Imaging 2024; 58:332-340. [PMID: 39308487 PMCID: PMC11415326 DOI: 10.1007/s13139-024-00868-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: 12/26/2023] [Revised: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 09/25/2024] Open
Abstract
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.
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Affiliation(s)
- Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | | | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Kritin Shankar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Arivan Ramachandran
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Gaurav Prakash
- Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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2
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Vogl TJ, Ketelsen HJ, Mahmoudi S, Scholtz JE, Koch V, Grünewald LD, Wild P, Stoever T, Bernatz S. CT-guided core needle biopsies of head and neck tumors: a comprehensive monocenter analysis of safety and outcomes. Eur Radiol 2024; 34:5370-5378. [PMID: 38221584 DOI: 10.1007/s00330-023-10541-2] [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: 06/05/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Although core needle biopsy is an important tool in minimally invasive tissue sampling and diagnostics for head and neck masses, comprehensive data about safety and outcomes is lacking. PURPOSE To retrospectively evaluate the diagnostic performance and safety of computed tomography (CT)-guided percutaneous core needle biopsy of head and neck masses. MATERIAL AND METHODS This retrospective single-center study included patients from 04/2007 to 12/2021, and a total of 156 core needle biopsies were evaluated. The initial histopathological results were compared with the long-term final diagnosis to evaluate the diagnostic yield of CT-guided core needle biopsies. The patients' age, sex, and history of malignancy, as well as procedural complications and radiation exposure were collected. RESULTS A total of 156 biopsies of 150 patients (mean age 56 years ± 17; 89 men) were evaluated. 57.3% (86/150) of patients had a history of malignancy. 55.1% (86/156) of the lesions were accessed by an infrahyoid needle approach. 92.9% (145/156) of biopsies yielded conclusive results. There were no false positives and 4 false negatives, resulting in a total false negative rate of 2.7% (4/145) and a total diagnostic yield of 90.4% (141/156). There were nine puncture-related complications (9/156-5.7%). None of the complications required further reintervention. The average dose length product was 311.3 mGy × cm. CONCLUSION CT-guided core needle biopsies of head and neck masses showed excellent results with high diagnostic yield and clinical safety. CLINICAL RELEVANCE STATEMENT General anesthesia for open biopsy carries a higher risk for elderly patients, and fine needle aspiration has a poor reputation in terms of its diagnostic yield. This study focuses on safety and diagnostic yield of CT-guided core needle biopsies. KEY POINTS • CT-guided core needle biopsy in head and neck tumors was a reliable and safe procedure. • The most common cause for an inconclusive biopsy result was a shortage of tissue collected during the biopsy. • During our study period of nearly 15 years, the radiation exposure of head and neck biopsies decreased.
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Affiliation(s)
- Thomas Joseph Vogl
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Heinrich Johannes Ketelsen
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Scherwin Mahmoudi
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Vitali Koch
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Leon David Grünewald
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Peter Wild
- Dr. Senckenbergisches Institute of Pathology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Timo Stoever
- Department of Otorhinolaryngology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Simon Bernatz
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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3
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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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4
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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: 17] [Impact Index Per Article: 8.5] [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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7
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Feng SM, Tan S, Yao XY, Lin YH, Liu HD, Ma LX, Li P, Guo YL, Zheng PH, Hu K. The value of ultrasound-guided fine needle aspiration in the diagnosis of diffuse large B-cell lymphoma: A single center experiment. Eur J Radiol 2022; 157:110567. [DOI: 10.1016/j.ejrad.2022.110567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022]
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8
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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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9
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Chan A, Scarpa Carniello JV, Gao Q, Sigler A, Baik J, Roshal M, Lin O. Role of Flow Cytometric Immunophenotyping for Classic Hodgkin Lymphoma in Small Biopsy and Cytology Specimens. Arch Pathol Lab Med 2021; 146:462-468. [PMID: 34293084 DOI: 10.5858/arpa.2020-0795-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Alexander Chan
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jose Victor Scarpa Carniello
- Cytopathology (Scarpa Carniello, Lin) Services, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qi Gao
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison Sigler
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeeyeon Baik
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mikhail Roshal
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York.,Roshal and Lin contributed equally as senior authors
| | - Oscar Lin
- From the Hematopathology (Chan, Gao, Sigler, Baik, Roshal, Lin), Memorial Sloan Kettering Cancer Center, New York, New York.,Cytopathology (Scarpa Carniello, Lin) Services, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.,Roshal and Lin contributed equally as senior authors
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10
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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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11
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Calvani J, de Masson A, de Margerie-Mellon C, de Kerviler É, Ram-Wolff C, Gruber A, Meignin V, Brice P, Sadoux A, Mourah S, Bagot M, Battistella M. Image-guided lymph node core-needle biopsy predicts survival in mycosis fungoides and Sézary syndrome. Br J Dermatol 2021; 185:419-427. [PMID: 33400272 DOI: 10.1111/bjd.19796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prognosis of Sézary syndrome (SS) and mycosis fungoides (MF) depends on lymph node (LN) involvement. The usefulness of LN image-guided core-needle biopsies (CNBs), instead of surgical sampling, has been poorly evaluated. OBJECTIVES To determine the prognostic value of LN CNB in MF/SS. METHODS A retrospective search was conducted to identify all LN biopsy specimens of MF/SS between 2008 and 2019. Biopsies were staged according to the International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer (ISCL/EORTC) criteria. We performed immunolabelling and determined the tumour clone frequency (TCF) by high-throughput sequencing of the T-cell receptor beta locus. RESULTS We included 119 consecutive biopsies from 100 patients, 45 with MF and 55 with SS. N1, N2 and N3 stages were diagnosed in 34 (29%), 26 (22%) and 59 (49%) cases, respectively. The TCF, Ki67 index, and percentage of cells positive for thymocyte selection-associated high mobility group box protein (TOX), programmed cell death protein 1 (PD1), killer cell immunoglobulin-like receptor 3DL2 (KIR3DL2) and cluster of differentiation (CD)30 were all positively correlated with the N stage. Median overall survival (OS) for N1/N2 vs. N3 patients was 42 months (range 26-not reached) vs. 14 months (range 5-30), respectively (P < 0·001). In univariate analyses, an age > 75 years, LN short-axis diameter > 15 mm, N3 stage, presence of large-cell transformation, TOX > 60%, PD1 > 25%, Ki67 > 30%, KIR3DL2 > 15%, CD30 > 10% and TCF > 25% were identified as adverse prognostic factors. In multivariate analyses, only an age > 75 years and Ki67 index > 30% were associated with reduced OS. We developed a new prognostic index associating the N stage and the Ki67 index, which better discriminates N3 patients with poor prognosis. CONCLUSIONS CNB allows an objective assessment of the LN involvement in MF/SS, relevant for staging and prognosis.
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Affiliation(s)
- J Calvani
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France
| | - A de Masson
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | | | - É de Kerviler
- Department of, Radiology, Hôpital Saint-Louis APHP, Paris, France
| | - C Ram-Wolff
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - A Gruber
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - V Meignin
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France
| | - P Brice
- Department of, Hematology, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis APHP, Paris, France
| | - A Sadoux
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France
| | - S Mourah
- Department of, Solid Tumor Genomics, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - M Bagot
- Department of, Dermatology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
| | - M Battistella
- Department of, Pathology, Hôpital Saint-Louis APHP, Paris, France.,INSERM UMR-S976, Université de Paris, Paris, France
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12
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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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13
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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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Huang J, Zheng JX, Yang Y, Zhu D. Necrotizing lymphadenitis : A case report and literature review. Z Rheumatol 2020; 80:274-282. [PMID: 33241524 DOI: 10.1007/s00393-020-00929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Necrotizing lymphadenitis is a rare disease. It is often misdiagnosed because of the lack of typical clinical manifestations. It is worth noting that necrotizing lymphadenitis may be a precursor lesion of systemic lupus erythematosus or tumours, so regular follow-up is needed to facilitate early diagnosis. Here, we report a case and conduct a literature analysis summarizing the clinical features of necrotizing lymphadenitis and its treatment and management practices. CASE PRESENTATION A 16-year-old young woman presented with fever and lymphadenopathy as the main clinical manifestations, accompanied by a rash during fever that disappeared as the fever subsided. After completing imaging and laboratory examinations, we excluded other diseases such as infections, autoimmune diseases, and malignant tumours. Finally, we diagnosed the patient with necrotizing lymphadenitis based on the results of lymph node biopsy. The symptoms of the patient improved after glucocorticoid treatment, and she was followed up for half a year without recurrence of symptoms. CONCLUSION In the clinic, young women with fever and lymphadenopathy as major symptoms should be screened for necrotizing lymphadenitis to facilitate early diagnosis and treatment. Although necrotizing lymphadenitis is self-limiting, its clinical manifestations are similar to those of many diseases. Therefore, it is easily misdiagnosed. An in-depth understanding of the disease is conducive to early diagnosis and treatment in the clinic, thereby reducing further damage to the body and reducing unnecessary evaluation and treatment.
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Affiliation(s)
- J Huang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China
| | - J-X Zheng
- Department of Rheumatology and Immunology, the Affiliated Hospital of North Sichuan Medical College, 637000, Nanchong, China
| | - Y Yang
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China.
| | - D Zhu
- Department of Rheumatology and Immunology, Daping Hospital, Army Medical University, No. 10, Changjiang Branch Road, Yuzhong District, 400042, Chongqing, China.
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15
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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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16
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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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The diagnostic performance of ultrasound-guided core biopsy in the diagnosis of head and neck lymphoma: results in 226 patients. Int J Oral Maxillofac Surg 2020; 50:431-436. [PMID: 32739250 DOI: 10.1016/j.ijom.2020.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/30/2020] [Accepted: 07/02/2020] [Indexed: 01/21/2023]
Abstract
Many clinical guidelines for investigating lymphomas advise that surgical excision biopsy (SEB) should be performed for a confident diagnosis. It is increasingly recognized in clinical practice that ultrasound-guided core needle biopsy (USCNB) is a reliable diagnostic technique. We aimed to investigate the diagnostic efficacy of USCNB in head and neck lymphoma. A retrospective analysis of all diagnosed head and neck lymphomas between 2013 and 2018 was performed. Patient records, radiology and histopathology reports along with the biopsy technique: fine needle aspiration cytology (FNAC), USCNB, and SEB used were reviewed. The technique providing diagnosis and leading to initiation of treatment was identified. Two-hundred and thirty patients and 267 biopsy samples were included. A total of 226 patients underwent USCN. In 215 of 226 (95.1%) USCNB patients were fully diagnostic allowing for initiation of oncological treatment; 11 patients required a subsequent SEB to provide diagnosis. In four patients, SEB was the only investigation performed. Of the USCNB total number of procedures (number of patients n=230 is the same coincidentally as the number of USCNB procedures), 215 of 230 (93.5%) were fully diagnostic samples. In the majority of cases, USCNB provided a definitive diagnosis allowing initiation of oncological treatment, avoiding the need for SEB. USCNB should be considered the first-line diagnostic modality in appropriate cases, as it reduces time to initiate treatment, costs and avoids patients having to undergo unnecessary surgery and possible complications.
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18
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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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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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20
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Wilczynski A, Görg C, Timmesfeld N, Ramaswamy A, Neubauer A, Burchert A, Trenker C. Value and Diagnostic Accuracy of Ultrasound-Guided Full Core Needle Biopsy in the Diagnosis of Lymphadenopathy: A Retrospective Evaluation of 793 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:559-567. [PMID: 31584214 DOI: 10.1002/jum.15134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Whole surgical lymph node excision (SNE) is considered the standard diagnostic method in the primary diagnosis of lymphadenopathy (LA) suspected of malignancy. Ultrasound-guided full core needle biopsy (UFCNB) offers an alternative method to SNE. This study examined the accuracy of UFCNB in the diagnosis of unexplained LA in 793 cases. METHODS From January 2006 to June 2015, a total of 793 cases of LA of unknown origin received a UFCNB. The lymph nodes were located peripherally (68%) or abdominally (32%). The final diagnoses from histopathologic examinations were non-Hodgkin lymphoma (n = 245), Hodgkin lymphoma (n = 53), solid nonlymphocytic lymph node metastases (n = 359), and benign LA (n = 136). The results of the biopsies were retrospectively evaluated with regard to sensitivity, specificity, and diagnostic accuracy. RESULTS In the total collective of 793 biopsies, the sensitivity of UFCNB was 94.4%; the specificity was 97.8%; and the diagnostic accuracy was 95.0%. In the subgroups, the following results were obtained: non-Hodgkin lymphoma (sensitivity, 97.2%), Hodgkin lymphoma (sensitivity, 88.7%), metastases (sensitivity, 93.3%), and benign LA (specificity, 97.8%). In 17 cases (2.2%), an additional rebiopsy of the lymph node was needed, and in 85 cases (10.7%), an additional SNE was performed. CONCLUSIONS Due to the diagnostic accuracy of 95.0% in the total collective, UFCNB seems to be an alternative diagnostic procedure to the standard procedure of SNE for LA of unknown origin. A prospective comparative study to definitively clarify the diagnostic value of UFCNB compared to SNE in the unexplained LA is warranted.
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Affiliation(s)
- Alexandra Wilczynski
- Department of Internal Medicine, Divisions of Gastroenterology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Christian Görg
- Department of Internal Medicine, Divisions of Gastroenterology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Nina Timmesfeld
- Institute for Medical Biometry and Epidemiology, Bochum, Germany
| | - Annette Ramaswamy
- Department of Pathology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Andreas Neubauer
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Andreas Burchert
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
| | - Corinna Trenker
- Department of Hematology, Oncology, and Immunology, University Hospital Marburg und Giessen, Marburg, Germany
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Han J, Feng XL, Xu TY, Feng WQ, Liu MJ, Wang B, Qiu TL, Wang Y. Clinical value of contrast-enhanced ultrasound in transthoracic biopsy of malignant anterior mediastinal masses. J Thorac Dis 2019; 11:5290-5299. [PMID: 32030246 DOI: 10.21037/jtd.2019.11.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Given low incidence and high heterogeneity, the treatment strategies of anterior mediastinal masses (AMMs) are diverse based on pathology. The purpose of the study is to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of malignant AMMs when compared with that of ultrasound (US) alone and to screen lesions that are more suitable for CEUS evaluation and guidance. Methods We reviewed all the US- and CEUS-guided transthoracic core needle biopsy (CNB) of AMMs performed in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between July 2013 and April 2019. A total of 68 patients (mean age 36 years; male-female ration 1.6:1) who were suspected with malignant AMMs were enrolled in the study. Among them, 20 patients received pre-biopsy CEUS examination (CEUS group); 48 patients underwent conventional US examination and guidance (US group). Demographic, radiologic, pathologic, medical records, and biopsy procedure details were retrospectively reviewed and compared between the two groups. Results The display of internal necrosis areas was significantly improved when compared with that of the conventional US (70%, 30%; P=0.008). Specifically, CEUS improved the diagnostic accuracy of US-guided transthoracic biopsy (95.0%, 79.2%; P=0.210) and especially for AMMs exceeding 10 cm (100%, 68.2%; P=0.040) and carcinoma (100%, 0%; P=0.048). The number of punctures in US group and CEUS group was 2.6 and 4.4 times, respectively (P<0.001). In case of similar number of punctures (1 to 3 times), CEUS improved diagnostic accuracy when compared to that of the conventional US (100%, 75%; P=0.486). The technical success rate was 100% (68/68). In both groups, patients did not exhibit symptomatic complications such as bleeding, pneumothorax, or hemoptysis after the biopsy. Conclusions The application of CEUS in transthoracic biopsy of malignant AMMs improved diagnostic accuracy when compared with conventional US and especially played more important role in lesions exceeding 10 cm and presumptive clinical carcinoma.
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Affiliation(s)
- Jie Han
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Li Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tian-Yu Xu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wen-Qi Feng
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Meng-Jia Liu
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bo Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ting-Lin Qiu
- Cancer Quality Control Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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22
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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: 7] [Impact Index Per Article: 1.4] [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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23
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Dvorak P, Hoffmann P, Simkovic M, Jandura J, Nova M. Is percutaneous computed tomography-guided biopsy sufficient to establish indolent lymphoma transformation? Arch Med Sci 2019; 15:1443-1453. [PMID: 31749872 PMCID: PMC6855164 DOI: 10.5114/aoms.2018.79573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to retrospectively evaluate the technical features, efficacy, accuracy, and relevant complications of computed tomography-guided biopsies in various anatomical localizations when diagnosing indolent lymphoma transformations, relapses, duplicate malignant diseases or benign processes. MATERIAL AND METHODS From December 2007 to December 2017, 81 percutaneous biopsy procedures in 72 patients for tumors, sizes 17-232 mm in diameter (median length: 39 mm), were performed in patients with known indolent lymphomas in their clinical history. The patients were men in 41 cases and women in 31 cases, aged 36 to 86 years. RESULTS In 79 cases (97.5%; 95% CI: 91.3-99.7) results were true positive or true negative; only 2 interventions (2.5%; 95% CI: 0.3-8.6) were histologically false negative. Transformation was verified in 29 cases (35.8%; 95% CI: 25.4-47.2), relapses in 30 cases (37%; 95% CI: 26.6-48.5), duplicate malignancy in 15 cases (18.5%; 95% CI: 10.8-28.7) and benign processes in 7 cases (8.7%; 95% CI: 3.5-17.0). Eight complications in total were revealed, 7 of which were in consequence of thoracic cavity biopsy. A statistically significant relationship between the complication incidence and anatomical localization in the thoracic cavity was identified (p = 0.0104). CONCLUSIONS Percutaneous CT guided biopsy performed in patients with a history of indolent lymphoma had high accuracy in establishing the correct diagnosis regarding transformation, relapse, duplicate malignancy or a benign process. Simultaneously, the complication rate was low.
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Affiliation(s)
- Petr Dvorak
- Department of Radiology, University Hospital, Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- Department of Radiology, University Hospital, Hradec Kralove, Czech Republic
| | - Martin Simkovic
- 4 Department of Internal Medicine – Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Jandura
- Department of Radiology, University Hospital, Hradec Kralove, Czech Republic
| | - Marketa Nova
- The Fingerland Department of Pathology, University Hospital, Hradec Kralove, Czech Republic
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24
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Wang Z, Shi H, Zhang X, Pan J, Jin Z. Value of CT-guided percutaneous needle biopsy of bone in the diagnosis of lymphomas based on PET/CT results. Cancer Imaging 2019; 19:42. [PMID: 31234926 PMCID: PMC6591857 DOI: 10.1186/s40644-019-0230-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Haifeng Shi
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaobo Zhang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jie Pan
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, 100730, China.
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25
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Gilbert RWD, Bird BH, Murphy MG, O'Boyle CJ. Should laparoscopic lymph node biopsy be the preferred diagnostic modality for isolated abdominal lymphadenopathy? ACTA ACUST UNITED AC 2019; 26:e341-e345. [PMID: 31285678 DOI: 10.3747/co.26.4170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Isolated abdominal lymphadenopathy is frequently detected, but often challenging to diagnose. To obtain a tissue diagnosis, percutaneous biopsy (pb) or laparoscopic biopsy (lb) is often undertaken. The safety profiles and diagnostic accuracy of pb and lb within the abdomen are both poorly defined. Methods In this retrospective analysis, we identified all patients who underwent lb or pb for isolated abdominal lymphadenopathy at our institute during 2008-2016. Results Of 62 patients who underwent nodal biopsy for isolated abdominal lymphadenopathy, 33 underwent lb and 29 underwent pb. For the 33 patients who underwent lb, the procedure was diagnostic in 100% of cases; for the 29 who underwent pb, the procedure was diagnostic in 18 cases (62.1%). Both procedures were safe, with similar complication rates (6.0% for lb; 7.0% for pb). Conclusions Our results establish that lb and pb are both safe and reliable in the setting of isolated abdominal lymphadenopathy. We also demonstrate that each procedure has situational advantages. A pb should be considered to be the upfront diagnostic modality, particularly when anatomic or disease factors favour its success. In situations in which it is felt that pb cannot safely access the lymphadenopathy or in disease states in which the yield of a core biopsy will be insufficient, lb should be strongly considered. Examples include extra-retroperitoneal lymphadenopathy and cases of suspected lymphoma.
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Affiliation(s)
- R W D Gilbert
- School of Medicine, University College Cork, Cork, Ireland.,Department of General Surgery, University of Ottawa, Ottawa, ON
| | - B H Bird
- School of Medicine, University College Cork, Cork, Ireland.,Department of Haematology and Oncology, Bon Secours Hospital, Cork, Ireland
| | - M G Murphy
- School of Medicine, University College Cork, Cork, Ireland.,Department of Diagnostic and Interventional Radiology, Bon Secours Hospital, Cork, Ireland
| | - C J O'Boyle
- School of Medicine, University College Cork, Cork, Ireland.,Department of Surgery, Bon Secours Hospital, Cork, Ireland
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26
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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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27
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Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures. J Pediatr (Rio J) 2019; 95:54-60. [PMID: 29291396 DOI: 10.1016/j.jped.2017.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/22/2017] [Accepted: 10/18/2017] [Indexed: 12/30/2022] Open
Abstract
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.
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28
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Pediatric abdominal non‐Hodgkin's lymphoma: diagnosis through surgical and non‐surgical procedures. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Özel D, Aydın T. A clinical compilation of lymph node pathologies comparing the diagnostic performance of biopsy methods. J Ultrasound 2018; 22:59-64. [PMID: 30284690 DOI: 10.1007/s40477-018-0321-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023] Open
Abstract
PURPOSE It is critical to obtain sufficient tissue, both in quality and quantity, in biopsy applications for histopathological review. Our aim was to compare fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) techniques in terms of their diagnostic performance in lymph node biopsies. This was a clinical compilation, and histopathological results from biopsies were also evaluated. METHODS A total of 242 patients and 246 lymph nodes were prospectively evaluated. All histopathologic specimens were obtained through ultrasonography-guided biopsies performed at our institute between April 2015 and October 2017. Histopathological results were grouped according to diagnostic performance, and the mean performance scores of the two methods were compared. RESULTS For FNAC, the mean diagnostic score was calculated to be 1.63, whereas for CNB, the mean diagnostic score was calculated to be 1.89. The difference between diagnostic scores of the two techniques was statistically significant (p < 0.01). CONCLUSION We recommend that interventional radiologists perform vacuum-assisted biopsies if there are no financial hindrances or evidence of psychological issues in patients. We recommend this not only for lymph nodes of malignant appearance but also for those that appear benign.
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Affiliation(s)
- Deniz Özel
- Radiology Clinic, Okmeydanı SUAM Hospital, Sağlık Bilimleri University, Şişli İstanbul, 34384, Istanbul, Turkey.
| | - Tamer Aydın
- Pathology Clinic, Okmeydanı Hospital, Sağlık Bilimleri University, Istanbul, Turkey
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30
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Yang XL, Wang Y, Bao Y, Liang SB, He SS, Chen DM, Chen HY, Lu LX, Chen Y. Additional Cervical Lymph Node Biopsy is Not a Significant Prognostic Factor for Nasopharyngeal Carcinoma in the Intensity-Modulated Radiation Therapy Era: A Propensity Score-matched Analysis from an Epidemic Area. J Cancer 2018; 9:2844-2851. [PMID: 30123353 PMCID: PMC6096379 DOI: 10.7150/jca.25505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/09/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: This study aimed to evaluate the prognostic value of cervical lymph node biopsy and whether different biopsy methods would lead different outcomes in NPC in the intensity-modulated radiotherapy (IMRT) era. Material and Methods: 1492 patients with biopsy-proven, non-metastatic NPC, and treated by IMRT with or without chemotherapy were retrospectively reviewed. Cervical lymph node biopsy was performed in 183 (12.3%) patients: 61(4.1%) by needle puncture and 118(7.9%) by excision biopsy. Propensity-score matching was used to match patients in both arms at an equal ratio. Overall survival (OS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRFS), and nodal relapse-free survival (NRFS) were assessed using the Kaplan-Meier method and compared using the log-rank test. Independent prognostic factors were identified using the Cox proportional hazards model. Results: In the original cohort of 1492 patients, patients receiving cervical lymph node biopsy had comparable survival (OS: P = 0.736, DMFS: P = 0.749, LRFS: P = 0.538, NRFS: P = 0.093,) with patients receiving isolated napharynx biopsy. The results for the propensity-match cohort of 316 patients were similar. Interestingly, compared with the control group and needle puncture biopsy group, a slightly lower nodal recurrence rate was observed in the excision biopsy group (P = 0.082 and P = 0.072, respectively). Adjusting for the known prognostic factors in multivariate analysis, cervical biopsy did not cause a higher risk of death, distant metastasis, or nodal relapse. Conclusions: Pretreatment cervical lymph node biopsy is not associated with impaired survival in NPC, suggesting the resist of the biopsy and more aggressive treatment after the biopsy may be unnecessary.
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Affiliation(s)
- Xing-Li Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center
| | - Yan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, Guangdong, P.R. China
| | - Yong Bao
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, Guangdong, P.R. China
| | - Shao-Bo Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center.,Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, China
| | - Sha-Sha He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center
| | - Dan-Ming Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, Guangdong, P.R. China
| | - Hai-Yang Chen
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li-Xia Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, Guangdong, P.R. China
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31
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McQueen AS, Bhatia KS. Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin Radiol 2017; 73:81-93. [PMID: 28985885 DOI: 10.1016/j.crad.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/25/2023]
Abstract
High-resolution ultrasound (US) provides superb anatomical detail in the superficial anatomy of the neck and has become the first-line imaging investigation for neck lumps and a crucial component of clinical pathways. In this article, a wide range of advances in neck US are described with a focus on the emerging role of ultrasound elastography. Selected examples of clinical utility are presented across a spectrum of scenarios with discussion of newer applications, service delivery, and training issues. The changing role of the neck ultrasound practitioner and the future of the technique in the head and neck are considered.
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Affiliation(s)
- A S McQueen
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK.
| | - K S Bhatia
- Department of Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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32
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Farndon S, Behjati S, Jonas N, Messahel B. How to use… lymph node biopsy in paediatrics. Arch Dis Child Educ Pract Ed 2017; 102:244-248. [PMID: 28468821 DOI: 10.1136/archdischild-2015-309634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/26/2022]
Abstract
Lymphadenopathy is a common finding in children. It often causes anxiety among parents and healthcare professionals because it can be a sign of cancer. There is limited high-quality evidence to guide clinicians as to which children should be referred for lymph node biopsy. The gold standard method for evaluating lymphadenopathy of unknown cause is an excision biopsy. In this Interpretation, we discuss the use of lymph node biopsy in children.
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Affiliation(s)
- Sarah Farndon
- Cancer Genome Project, Wellcome Trust Sanger Institute, Cambridge, UK.,Developmental Biology and Cancer Programme, University College London, Institute of Child Health, London, UK
| | - Sam Behjati
- Cancer Genome Project, Wellcome Trust Sanger Institute, Cambridge, UK.,Department of Paediatric Haematology/Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Nico Jonas
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Boo Messahel
- Department of Paediatric Haematology/Oncology, Addenbrooke's Hospital, Cambridge, UK
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33
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Lumachi F, Fassina A, Tozzoli R, Tregnaghi A, Basso SMM, Ermani M. Image-guided fine-needle aspiration cytology and flow cytometry phenotyping of neck lymphadenopathy for the diagnosis of recurrent lymphoma. Clin Otolaryngol 2017; 42:668-672. [PMID: 27882691 DOI: 10.1111/coa.12797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- F Lumachi
- Department of Surgery, Oncology and Gastroenterology, School of Medicine, University of Padua, Padova, Italy
| | - A Fassina
- 2nd Pathology and Cytopathology Unit, Department of Medicine, School of Medicine, University of Padua, Padova, Italy
| | - R Tozzoli
- Clinical Pathology Laboratory, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - A Tregnaghi
- Radiology Service, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - S M M Basso
- Department of Surgery, General Surgery, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - M Ermani
- Statistic and Informatics Unit, Department of Neurosciences, School of Medicine, University of Padua, Padova, Italy
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34
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Abdulla M, Laszlo S, Triumf J, Hedström G, Berglund M, Enblad G, Amini RM. Core needle biopsies for the diagnosis of diffuse large B-cell lymphoma - a great concern for research. Acta Oncol 2017; 56:106-109. [PMID: 27796168 DOI: 10.1080/0284186x.2016.1245863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Maysaa Abdulla
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Sofia Laszlo
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Johanna Triumf
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Gustaf Hedström
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Mattias Berglund
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Novum, Huddinge, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Rose-Marie Amini
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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35
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Battistella M, Sallé de Chou C, de Bazelaire C, Cayuela J, de Kerviler E, Bagot M, Janin A. Lymph node image-guided core-needle biopsy for cutaneous T-cell lymphoma staging. Br J Dermatol 2016; 175:1397-1400. [DOI: 10.1111/bjd.14850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- M. Battistella
- Inserm; U1165; Paris F-75010 France
- Laboratoire de Pathologie; UMR-S 1165; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
- Department of Pathology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
| | - C. Sallé de Chou
- Laboratoire de Pathologie; UMR-S 1165; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
- Department of Pathology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
- Department of Dermatology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
| | - C. de Bazelaire
- Inserm; U1165; Paris F-75010 France
- Department of Diagnostic and Interventional Radiology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
- Faculté de Médecine; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
| | - J.M. Cayuela
- Department of Molecular Haematology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
| | - E. de Kerviler
- Inserm; U1165; Paris F-75010 France
- Department of Diagnostic and Interventional Radiology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
- Faculté de Médecine; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
| | - M. Bagot
- Department of Dermatology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
- Faculté de Médecine; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
- Inserm; U976; Paris F-75010 France
| | - A. Janin
- Inserm; U1165; Paris F-75010 France
- Laboratoire de Pathologie; UMR-S 1165; Université Paris Diderot; Sorbonne Paris Cité; Paris F-75010 France
- Department of Pathology; AP-HP; Hôpital Saint-Louis; Paris F-75010 France
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36
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Johl A, Lengfelder E, Hiddemann W, Klapper W. Core needle biopsies and surgical excision biopsies in the diagnosis of lymphoma-experience at the Lymph Node Registry Kiel. Ann Hematol 2016; 95:1281-6. [PMID: 27236576 DOI: 10.1007/s00277-016-2704-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/20/2016] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Alice Johl
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Arnold-Heller-Str. 3, Haus 14, 24105, Kiel, Germany
| | - Eva Lengfelder
- 3rd Department of Internal Medicine, University Hospital Mannheim, Mannheim, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital of Munich, Munich, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Arnold-Heller-Str. 3, Haus 14, 24105, Kiel, Germany.
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Abstract
Abstract
The diffuse aggressive large B-cell lymphomas are a heterogeneous group of B-cell malignancies. Although many are readily recognized due to characteristic clinical and pathologic features, several problematic areas still exist in diagnosis of these lymphomas due to a variety of reasons that include imprecise or difficult-to-apply diagnostic criteria, gaps in our understanding of lymphoma biology, and limitations in technologies available in the clinical laboratory compared to the research laboratory. This may result in some degree of confusion in the pathology report, particularly if the issues are not clearly explained, leading to frustration or misinterpretation on the part of the reader. In this review, I will discuss the pathologic features of a subset of the WHO 2008 classification diffuse aggressive large B-cell lymphomas, focusing on areas in which difficulties exist in diagnosis and/or biomarker marker assessment. A deeper understanding of the issues and areas of uncertainty due to limitations in our knowledge about the biology of these diseases should lead to better communication between pathologists and clinicians.
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