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Wu CC, Leng E, Killeen TF, Faber EB, Harmon JV. Surgical Lymph Node Biopsy for the Diagnosis of Lymphoma: A Case Report. Cureus 2023; 15:e49063. [PMID: 38125250 PMCID: PMC10731131 DOI: 10.7759/cureus.49063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
We report the diagnosis, treatment, and outcomes of a 52-year-old woman who originally presented to her primary care provider with adenopathy. Core needle biopsy (CNB) was inconclusive as it could not distinguish between follicular and diffuse large B-cell lymphomas (DLBCLs). A left axillary surgical lymph node biopsy was performed and demonstrated that the patient had a DLBCL arising from grade 3 follicular lymphoma. We discuss the limitations of CNB and the value of surgical lymph node biopsy in the diagnosis of lymphoma. The patient recovered from the biopsy without complications, and chemotherapy was initiated after the procedure. The patient has now remained in complete remission at 22 months.
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Affiliation(s)
- Chih Ching Wu
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Ethan Leng
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Trevor F Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, USA
| | - Erik B Faber
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - James V Harmon
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
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Gül Mutlu Y, Balık Aydın B, Çakır A, Canöz Ö, Erol C, Sevindik ÖG. Should Core Needle Lymph Node Biopsy be a Relevant Alternative to Surgical Excisional Biopsy in Diagnostic Work Up of Lymphomas? Eurasian J Med 2023; 55:114-119. [PMID: 37403909 PMCID: PMC10440969 DOI: 10.5152/eurasianjmed.2023.0060] [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: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Surgical excisional biopsy is accepted as the standard of care approach in the diagnosis of lympho- mas. Financial issues related to the increased cost and the invasive nature of the procedure forced physicians to use some alternative diagnostic methods. Percutaneous core needle biopsy, which gained a reputation for the diagnosis of lymphomas with the advent of improved pathological, immunohistochemical, and molecular analysis, made it possible to have an accurate diagnosis with limited tissue samples. In this retrospective study, we aimed to compare the diagnostic yield of surgical excisional biopsy and core needle biopsy. MATERIALS AND METHODS This study included 131 patients who were diagnosed with lymphoma with a nodal biopsy which was acquired via surgical excisional biopsy or core needle biopsy between 2014 and 2020 in our center. Around 68 patients underwent surgical excisional biopsy and the remaining 63 underwent core needle biopsy. Samples that allowed to the identification of the exact tumor type and/or subtype were accepted as fully diagnostic. Sufficient amount of tissue that the pathologist could have any suspicious findings considering malignant lymphoma was classified as partial diagnostic group. Inadequate samples were the ones who were not enough to report any final diagnosis. RESULTS The patients who underwent a core needle biopsy were significantly older than the patients who underwent to surgical excisional biopsy (56.8 vs. 47.6, P = .003). Despite the full diagnostic ability of surgical excisional biopsy outperformed core needle biopsy (95.2 % vs. 83.8 %, P=.035), in 92.6% of the patients whose tissue samples were obtained via core needle biopsy were accepted to have a sufficient diagnosis to initiate the treatment and not required a second biopsy, which was comparable with the ones achieved by surgical excisional biopsy (92.6% vs. 95.2%, P = .720). CONCLUSION According to the results obtained in our study, we may conclude that core needle biopsy is a viable and comparable alternative to surgical excisional biopsy, offering a less invasive and less-expansive approach.
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Affiliation(s)
- Yaşa Gül Mutlu
- Department of Hematology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Aslı Çakır
- Department of Pathology, Istanbul Medipol University, Istanbul, Turkey
| | - Özlem Canöz
- Department of Pathology, Erciyes University, Kayseri, Turkey
| | - Cengiz Erol
- Department of Radiology, Istanbul Medipol University, Istanbul, Turkey
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Msheik A, Saad F, Saad WA, Al Mokdad Z, Tarhini C, Bayram M. Navigating treatment options for sacral spine lymphoma: A medical journey. Int J Surg Case Rep 2023; 107:108327. [PMID: 37210801 DOI: 10.1016/j.ijscr.2023.108327] [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: 04/14/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Early clinical presentations of spinal processes involving the epidural space are often vague and can mimic other spinal nerve impingements. Patients with NHLs frequently experience neurological problems due to metastatic spinal cord compression (MSCC). CASE PRESENTATION In this case report, we present a 66-year-old female patient who was diagnosed with diffuse large B-cell lymphoma (DLCBL) of the sacral spine after a recurrence of cauda equine syndrome. The patient initially presented with back discomfort, radicular pain, and muscle weakness, which progressed to weakness in the lower extremities and bladder dysfunction over a few weeks. The patient was treated by surgical decompression and the biopsy result revealed a diagnosis of DLBCL. Further workup proved the tumor is primary and the patient as treated with radio- and chemotherapy. CLINICAL DISCUSSION The varied distribution of symptoms based on the spinal level of the lesion makes early clinical diagnosis of spinal NHL challenging. In this case, the patient's initial symptoms closely resembled intervertebral disc herniation or other spinal nerve impingements, which delayed the diagnosis of NHL. The abrupt onset and progression of neurological symptoms in the lower extremities and bladder dysfunction raised the suspicion of MSCC. CONCLUSION NHLs can present as metastatic spinal cord compression, which can cause neurological problems. Early clinical diagnosis of spinal NHLs is challenging due to the vague and varied presentations. A high index of suspicion for MSCC should be maintained in patients with NHLs who present with neurological symptoms.
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Affiliation(s)
- Ali Msheik
- Neurological Surgery, Lebanese University Faculty of Medicine, Hadath, Lebanon.
| | - Firas Saad
- Oncology, St. George's University School of Medicine, New York, USA
| | - Wajih A Saad
- Oncology, Lebanese University Faculty of Medicine, Beirut, Lebanon
| | - Zeinab Al Mokdad
- Registered Nurse, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Charif Tarhini
- Hematology-oncology Fellow, University of Balamand, Beirut, Lebanon
| | - Mohamad Bayram
- Neurological Surgery, Al Rassoul Al-Aazam Hospital, Beirut, Lebanon
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Zhang W, Yang G, Xu J, Ni T, Tang W, Zhou M. Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes. BMC Surg 2023; 23:71. [PMID: 36991353 DOI: 10.1186/s12893-023-01964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
AIM Summarized the incidence of bleeding after ultrasound-guided coarse needle biopsy (US-CNB) of benign cervical lymph nodes. METHODS We retrospectively examined the clinical and follow-up records of 590 patients with benign cervical lymph node disease who underwent US-CNB at our hospital during February 2015-July 2022 and were confirmed to have the disease by CNB and surgical pathology. The number of cases, types of diseases, and degree of bleeding of all patients with bleeding after US-CNB were statistically analyzed. RESULTS Of the 590 patients, bleeding was noted in 44 cases(7.46%), and the infectious lymph node bleeding rate was 9.48%. Infectious lymph nodes were more likely to bleed than noninfectious lymph nodes after CNB, ,x2 = 8.771; P = 0.003, Lymph nodes with pus were more likely to bleed than solid lymph nodes after CNB, x2 = 4.414; P = 0.036,. CONCLUSION The bleeding of all patients after CNB was minor bleeding. Infected lymph nodes bleed more frequently than noninfected lymph nodes. Lymph nodes with mobility and a large pus cavity, are more likely to bleed after CNB.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang.
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, China.
| | - Gaoyi Yang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Jianping Xu
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Tu Ni
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Wei Tang
- Department of Ultrasonography,Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine(Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital)), hangzhou, Zhejiang, China, No.208 Huancheng East Road, Hangzhou, Zhejiang
| | - Meiling Zhou
- Department of Pathology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine (Integrated Chinese and Western Hospital of Zhejiang Province, Hangzhou Red Cross Hospital), No.208 Huancheng East Road, 310003, Hangzhou, Zhejiang, China
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Stacey A, Marks AJ, Naresh KN. Variant histology in nodular lymphocyte predominant Hodgkin lymphoma in an adult population: disease investigations and characteristics from a retrospective cohort. J Clin Pathol 2023; 76:137-140. [PMID: 35483890 DOI: 10.1136/jclinpath-2022-208190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
A subset of variant histological patterns of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) has been associated with advanced disease stage and increased recurrence risk. Histopathology reports on core needle (CNB) and/or surgical excision biopsies (SEB) for 33 adult patients with NLPHL were examined for variant histology prevalence and association with disease stage and clinical outcome. Variant histological pattern was present in 13/33 patients (39%). Obtained tissue was inadequate for diagnosis in 1/23 (4.3%) cases of CNB. Variant histology was associated with stage IV disease at presentation (p<0.001). While SEB should be the procedure of choice in workup of patients for a diagnosis of NLPHL, CNB is an alternate option when SEB is contraindicated or difficult to undertake. Diagnostic reports should specifically note presence of variant histological patterns. Although late-stage disease was associated with progression or recurrence, overall prognosis is excellent for patients with NLPHL.
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Affiliation(s)
- Arthur Stacey
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Kikkeri N Naresh
- Histopathology, Imperial College London Centre for Haematology, London, UK.,Section of Pathology, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Schleder S, Jung EM, Schicho A, Schreyer AG, Habicher W, Grassinger J, Dollinger M. Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic. Clin Hemorheol Microcirc 2023; 83:397-408. [PMID: 36683499 DOI: 10.3233/ch-221680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.
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Affiliation(s)
- Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas G Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Werner Habicher
- Department of Othorhinolaryngology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Marco Dollinger
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Core Needle Biopsy in Lymphoma Diagnosis: The Diagnostic Performance and the Role of the Multidisciplinary Approach in the Optimization of Results. Am J Surg Pathol 2023; 47:111-123. [PMID: 36395467 DOI: 10.1097/pas.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To compare the diagnostic accuracy of core needle biopsies (CNBs) and surgical excisional biopsies (SEBs), samples of lymphoid proliferation from a single institution from 2013 to 2017 (N=476) were divided into groups of CNB (N=218) and SEB (N=258). The diagnostic accuracy of these samples was evaluated as a percentage of conclusive diagnosis, according to the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues . The contribution of clinical data, the assessment of sample adequacy by a pathologist during the procedure, the number and size of fragments, the needle gauge, the ancillary tests, and the type of lymphoid proliferation were also examined. The diagnostic accuracy of SEB was 97.3% and CNB 91.3% ( P =0.010). Additional factors considered essential for establishing the final diagnosis in some cases were: clinical information (20.6% CNB, 7.4% SEB; P <0.001); immunohistochemistry (96.3% CNB, 91.5% SEB; P =0.024); flow cytometry (12% CNB, 6.8% SEB; P =0.165); and other complementary tests (8.2% CNB, 17.3% SEB; P =0.058). Factors that did not influence performance were the evaluation of sample adequacy during the procedure, the number and size of fragments, and the needle gauge. Increased percentage of nondiagnostic CNB was observed in T-cell lymphomas (30%), followed by classic Hodgkin lymphoma (10.6%). The main limitation of CNB was the evaluation of morphologically heterogenous diseases. CNB is useful and safe in lymphoma diagnosis provided it is carried out by a team of experienced professionals. Having an interventional radiology team engaged with pathology is an essential component to achieve adequate rates of specific diagnoses in CNB specimens.
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Desai SH, Mwangi R, Ng WL, King RL, Maurer MJ, Cerhan JR, Feldman AL, Farooq U, Mou E, Habermann TM, Thompson CA, Wang Y, Witzig TE, Nowakowski GS. Increasing tissue requirements in lymphoma trials may exclude patients with high-risk disease or worse prognosis. Blood Adv 2022; 6:6180-6186. [PMID: 36170803 PMCID: PMC9791316 DOI: 10.1182/bloodadvances.2022007569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 01/22/2023] Open
Abstract
An enhanced understanding of the molecular heterogeneity of diffuse large B-cell lymphoma (DLBCL) has opened the door to clinical trials evaluating novel agents with subtype-specific activity. It is an emerging question whether core needle biopsies (CNB) can adequately meet the increasing tissue requirements of these clinical trials. This can potentially lead to selective enrollment of patients who can undergo excisional biopsy (EB). It is also important to know whether patients who can undergo extensive diagnostic work up differ in their disease characteristics and outcomes from those who cannot. In this observational study, we describe the characteristics, outcomes, and adequacy of diagnostic tissue in patients with newly diagnosed DLBCL and primary mediastinal large B-cell lymphoma who underwent EB vs CNB. Of the 1061 patients, 532 (49.8%) underwent EB and 529 (50.1%) underwent CNB. A significantly higher proportion of patients with CNB had advanced stage disease, an international prognostic index of ≥3, and inadequate tissue for molecular analyses. Patients with CNB had significantly worse 5-year event-free survival (67.6% vs 56.9%; hazard ratio [HR], 0.76; confidence interval [CI]95, 0.6-0.9, P < .001) and 5-year overall survival (76.4% vs 69.2%; HR, 0.8; CI95, 0.6-0.9, P < .001). Thus, patients who underwent CNB have poor-risk features and inferior outcomes on frontline chemoimmunotherapy, are more likely to have inadequate tissue for molecular analyses, and might not meet the tissue requirements of biomarker-driven clinical trials. Thus, the increasing tissue requirements of biomarker-driven clinical trials may result in the exclusion of patients with high-risk DLBCL who need novel agents.
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Affiliation(s)
- Sanjal H. Desai
- Division of Hematology, Department of Medicine
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | | | | | - Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Umar Farooq
- Department of Hematology, Oncology, Blood and Bone Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA
| | - Eric Mou
- Department of Hematology, Oncology, Blood and Bone Marrow Transplantation, University of Iowa Hospital and Clinics, Iowa City, IA
| | | | | | - Yucai Wang
- Division of Hematology, Department of Medicine
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Lymph node excisions provide more precise lymphoma diagnoses than core biopsies: a French Lymphopath network survey. Blood 2022; 140:2573-2583. [PMID: 35797472 DOI: 10.1182/blood.2022015520] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
According to expert guidelines, lymph node surgical excision is the standard of care for lymphoma diagnosis. However, core needle biopsy (CNB) has become widely accepted as part of the lymphoma diagnostic workup over the past decades. The aim of this study was to present the largest multicenter inventory of lymph nodes sampled either by CNB or surgical excision in patients with suspected lymphoma and to compare their diagnostic performance in routine pathologic practice. We reviewed 32 285 cases registered in the French Lymphopath network, which provides a systematic expert review of all lymphoma diagnoses in France, and evaluated the percentage of CNB and surgical excision cases accurately diagnosed according to the World Health Organization classification. Although CNB provided a definitive diagnosis in 92.3% and seemed to be a reliable method of investigation for most patients with suspected lymphoma, it remained less conclusive than surgical excision, which provided a definitive diagnosis in 98.1%. Discordance rates between referral and expert diagnoses were higher on CNB (23.1%) than on surgical excision (21.2%; P = .004), and referral pathologists provided more cases with unclassified lymphoma or equivocal lesion through CNB. In such cases, expert review improved the diagnostic workup by classifying ∼90% of cases, with higher efficacy on surgical excision (93.3%) than CNB (81.4%; P < 10-6). Moreover, diagnostic concordance for reactive lesions was higher on surgical excision than CNB (P = .009). Overall, although CNB accurately diagnoses lymphoma in most instances, it increases the risk of erroneous or nondefinitive conclusions. This large-scale survey also emphasizes the need for systematic expert review in cases of lymphoma suspicion, especially in those sampled by using CNB.
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The efficacy of incorporating ultrasound-guided core biopsy into the clinical workflow of indeterminate thyroid tumors. J Formos Med Assoc 2022; 121:2012-2019. [DOI: 10.1016/j.jfma.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
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Prediction of hemorrhagic complications after ultrasound-guided biopsy of the thyroid and neck. Eur Radiol 2022; 32:4177-4185. [DOI: 10.1007/s00330-021-08524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/18/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022]
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BAKKAL FK, GÜLHAN N, ERAVCI FC, KIZIL Y, AYDİL U. Head and neck lymphomas from otolaryngology perspective. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.948863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ultrasound core biopsies of neck lumps: an experience from a tertiary head and neck cancer unit. The Journal of Laryngology & Otology 2021; 135:799-803. [PMID: 34266504 DOI: 10.1017/s0022215121001833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Traditionally, fine needle aspiration cytology was the primary diagnostic investigation for head and neck lumps; however, ultrasound-guided core biopsy offers the advantage of preserving tissue architecture with increased tissue yield. This study reviews the diagnostic utility of ultrasound-guided core biopsy for investigating head and neck lumps. METHODS Overall, 287 ultrasound-guided core biopsies were reviewed between May 2017 and April 2019 at a single tertiary site for head and neck cancer. RESULTS On initial ultrasound-guided core biopsy, a diagnostic sample was obtained in 94.4 per cent of patients and in 83.7 per cent of patients with lymphoma. Where the initial ultrasound-guided core biopsy was non-diagnostic, 50 per cent of samples were diagnostic on repeat ultrasound-guided core biopsy. Overall, five complications were seen related to ultrasound-guided core biopsy, and all were managed conservatively. No cases of disease recurrence were identified at the biopsy site. CONCLUSION Ultrasound-guided core biopsy is a safe procedure with a high diagnostic yield when investigating head and neck lumps. Patients whose ultrasound-guided core biopsies were non-diagnostic should be considered for excisional biopsy over repeat ultrasound-guided core biopsy.
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Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience. J Am Soc Cytopathol 2021; 10:543-557. [PMID: 34088642 DOI: 10.1016/j.jasc.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although the diagnostic utility of lymph node fine-needle aspiration (FNA) is well established in the evaluation of metastatic malignancy, its value in the diagnosis of lymphoma is more controversial; yet, there is a growing trend among practitioners towards less-invasive procedures such as FNA and core needle biopsy (CNB). The guidelines recently published by the American Society for Clinical Pathology/College of American Pathology (CAP) regarding the workup of lymphoma include recommendations on the value and limitations of FNA. MATERIALS AND METHODS We reviewed 1237 image-guided lymph node aspirates from 695 procedures (410 nodes from 360 ultrasound [US]-guided cases, 799 from 309 endobronchial ultrasound [EBUS], 25 from 23 endoscopic ultrasound [EUS], and 3 from 3 computed tomography [CT]). RESULTS The majority (40 of 46, 87%) of lymph nodes suspected of lymphomatous involvement were aspirated under ultrasound. Core needle biopsy [CNB] was obtained for 41 (89%) lymph nodes, including all 40 US specimens. Flow cytometry (FC) was performed on 37 (80%) aspirates; aspirates without FC were from patients who had a history of Hodgkin lymphoma, or showed granulomata or non-hematologic malignancy onsite. Thirty-one (67%) lymph nodes were sent for review by hematopathology. Forty-two (91%) lymph node FNA/CNB yielded actionable diagnoses. Seventeen of 241(7%) cases aspirated for other indications (14 US, 3 EBUS) were involved by a lymphoproliferative process. All were reviewed by hematopathology. All 14 US cases had FC and CNB. CONCLUSION Our institutional approach towards lymph node cytopathology for lymphoma workup appears to be in accordance with the new CAP guidelines, and demonstrates a potential triage and workflow model for lymph node FNA specimens that allows for accurate diagnosis in cases where lymphoma is a consideration.
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Kshirsagar RS, Anderson M, Boeckermann LM, Gilde J, Shen JY, Meltzer C, Wang KH. The Adult Neck Mass: Predictors of Malignancy. Otolaryngol Head Neck Surg 2021; 165:673-681. [PMID: 33687292 DOI: 10.1177/0194599821996293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Distinguishing benign from malignant adult neck masses can be challenging because data to guide risk assessment are lacking. We examined patients with neck masses from an integrated health system to identify patient and mass factors associated with malignancy. STUDY DESIGN Retrospective cohort. SETTING Kaiser Permanente Northern California. METHODS The medical records of adults referred to otolaryngology in 2017 for a neck mass were evaluated. Bivariate and multivariable logistic regression analyses were performed. RESULTS Malignancy was found in 205 (5.0%) of the cohort's 4103 patients. Patient factors associated with malignancy included sex, age, and race/ethnicity. Males had more than twice the odds of malignancy compared with females (adjusted odds ratio [aOR] = 2.38). Malignancy rates increased with age, ranging from 2.1% for patients younger than 40 years to 8.4% for patients 70 years or older. White non-Hispanic patients had 1.75 times the risk of malignancy compared with patients of other race/ethnicities. The percentage of patients with malignancy increased with increasing minimum mass dimension, from 3.0% in patients with mass size <1 cm to over 31% in patients with mass sizes 2 cm or larger (P < .0001). Imaging-based mass factors most highly predictive of malignancy included larger minimum mass dimension (≥1.5 cm vs <1.5 cm: aOR = 3.87), multiple masses (2 or more vs 1: aOR = 5.07), and heterogeneous/ill-defined quality (aOR = 2.57). CONCLUSION Most neck masses referred to otolaryngology were not malignant. Increasing age, male sex, white non-Hispanic ethnicity, increasing minimum mass dimension, multiple neck masses, or heterogeneous architecture/ill-defined borders were associated with malignancy.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland, Oakland, California, USA
| | | | - Lauren M Boeckermann
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland, Oakland, California, USA
| | - Jason Gilde
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland, Oakland, California, USA
| | - Joseph Y Shen
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland, Oakland, California, USA
| | - Charles Meltzer
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Santa Rosa, Santa Rosa, California, USA
| | - Kevin H Wang
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland, Oakland, California, USA
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Mahmood N, Kaya G, Zhang TT, Topple J, Howlett DC. Sonographic appearances of facial lumps in adults with a focus on cheek masses: A pictorial essay. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:175-183. [PMID: 33295669 DOI: 10.1002/jcu.22959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/30/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Nadia Mahmood
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Guven Kaya
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Ting Ting Zhang
- Radiology Department, Brighton and Sussex NHS Trust, Brighton, UK
| | - Jane Topple
- Radiology Department, East Sussex University Hospitals Trust, Eastbourne, UK
| | - David C Howlett
- Radiology Department, East Sussex University Hospitals Trust, Eastbourne, UK
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Diagnostic accuracy of core biopsy in patients presenting with axillary lymphadenopathy and suspected non-breast malignancy. Eur J Surg Oncol 2021; 47:1575-1580. [PMID: 33579581 DOI: 10.1016/j.ejso.2021.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Excision biopsy has been the investigation of choice for patients presenting with pathological axillary lymphadenopathy without a breast abnormality. Core biopsy of nodes can provide sufficient tissue for diagnosis and has advantages in terms of morbidity and speed of diagnosis. This study evaluates the diagnostic accuracy of core biopsy in patients presenting with axillary lymphadenopathy. METHODS Between 2009 and 2019, 165 patients referred to the Edinburgh Breast Unit had a total of 179 axillary lymph node core biopsies. RESULTS 152 (92%) of the 165 initial core biopsies were deemed to contain adequate nodal tissue. Core biopsy correctly established malignancy in 75 of the 78 patients with haematological malignancy (96%) and in all 28 patients with metastatic carcinoma (100%) and correctly diagnosed benign changes in 49 of 57 (86%) patients with benign conditions. There were no false positives and no false negatives. In 67 (85.9%) of the 78 patients with haematological malignancy there was sufficient material in the first core biopsy to allow the pathologist to make an actionable diagnosis and not ask for more tissue sampling prior to treatment. There were no complications of core biopsy. On follow up, none of the patients with benign cores has been shown to have malignancy in the axilla and none with lymphoma had their initial disease incorrectly classified. CONCLUSIONS This study shows that core biopsy is now the investigation of choice for patients presenting with axillary lymphadenopathy even in those suspected as having lymphoma.
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Warshavsky A, Rosen R, Perry C, Muhanna N, Ungar OJ, Carmel-Neiderman NN, Fliss DM, Horowitz G. Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta-analysis. Head Neck 2020; 42:3051-3060. [PMID: 32748464 DOI: 10.1002/hed.26381] [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: 05/07/2020] [Revised: 06/06/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma. METHODS We conducted a meta-analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB. Patients with a diagnosis other than lymphoma were excluded. All cases diagnosed with lymphoma sufficient to guide treatment based on CNB outcome were considered accurate (actionable) results. A separate meta-analysis was performed for various lymphoma subtypes. RESULTS Three prospective and 19 retrospective studies, comprising 1120 patients, met the inclusion criteria. The rate of actionable lymphoma diagnoses following CNB ranged from 30% to 96.3%, with a random-effects model of 82.45% (95% confidence interval [CI] =0.76-0.88) and a fixed-effects model of 78.3% (95% CI =0.75-0.80). CONCLUSION CNB for cervical lymphadenopathy in lymphoma cases is relatively accurate in guiding treatment.
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Affiliation(s)
- Anton Warshavsky
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roni Rosen
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Chava Perry
- The Institute of Hematology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer J Ungar
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neiderman
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- The Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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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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20
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Elhamdoust E, Motamedfar A, Gharibvand MM, Jazayeri SN. Investigation of the value of ultrasound-guided core needle biopsy from pathologic lymph nodes to the diagnosis of lymphoma. J Family Med Prim Care 2020; 9:2801-2805. [PMID: 32984129 PMCID: PMC7491826 DOI: 10.4103/jfmpc.jfmpc_1260_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/06/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: In recent years, techniques with minimally invasive have been gradually developed and used in the diagnosis of lymphoma. Among minimally invasive techniques, core needle biopsy (CNB) has been widely accepted as an effective tool for the diagnosis of malignant lymphoma, carcinoma and deep tumors that are only accessible via CT or endoscopic-guided. This study was conducted to investigate of diagnostic value of ultrasound guided CNB in the diagnosis of lymphoma in all parts of the body compared to surgical excisional biopsy (SEB). Materials and Methods: This is an descriptive epidemiological study that was performed on patients with suspected lymphoma referred to the intervention ward of Golestan Hospital in Ahvaz in 2019. For all patients with suspected lymphoma, CNB of lymph nodes was performed by ultrasound-guided. Finally, the final diagnosis of CNB was compared with the results of surgical biopsy in the studied specimens. Results: In this study, 40 patients were evaluated with suspected lymphoma. At initial diagnosis with CNB, 12 (30%) had NHL, 19 (47.5%) had Hodgkin's lymphoma, and 2 had high-grade lymphoma. Of the 40 patients examined, 29 required IHC to confirm the diagnosis. In 8 cases, the final diagnosis was done using SEB. Final diagnosis in 9 (22.5%) patients was confirmed by CNB only. The CNB along with the IHC also led to the final diagnosis in 23 (57.5%) patients. However, another 8 patients required biopsy to confirm the diagnosis by SEB. Conclusion: The findings of this study indicated that US-CNB is a highly efficient method of diagnosis of lymphoma with high specificity, in the fastest possible mode and with the least complications.
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Affiliation(s)
- Elham Elhamdoust
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medicine, Ahvaz, Iran
| | - Azim Motamedfar
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medicine, Ahvaz, Iran
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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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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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A Nomogram to Predict the Outcome of Fine Needle Aspiration Cytology in Head and Neck Masses. J Clin Med 2019; 8:jcm8122050. [PMID: 31766590 PMCID: PMC6947452 DOI: 10.3390/jcm8122050] [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: 10/02/2019] [Revised: 11/07/2019] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Fine needle aspiration cytology (FNAC) is an important diagnostic tool for tumors of the head and neck. However, non-diagnostic or inconclusive results may occur and lead to delay in treatment. The aim of this study was to evaluate the factors that predict a successful FNAC. A retrospective search was performed to identify all patients who received an FNAC at the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna. The variables were patients’ age and sex, localization and size of the punctured structure, previous radiotherapy, experience of the head and neck surgeon, experience of the pathologist and the FNAC result. Based on these parameters, a nomogram was subsequently created to predict the probability of accurate diagnosis. After performing 1221 FNACs, the size of the punctured lesion (p = 0.0010), the experience of the surgeon and the pathologist (p = 0.00003) were important factors for a successfully procedure and reliable result. FNACs performed in nodes smaller than 20 mm had a significantly worse diagnostic outcome compared to larger nodes (p = 0.0004). In conclusion, the key factors for a successful FNAC are nodal size and the experience of the head and neck surgeon and the pathologist.
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Assaf N, Nassif S, Tamim H, Bazarbachi A, Zaatari G, Chakhachiro Z. Diagnosing Lymphoproliferative Disorders Using Core Needle Biopsy Versus Surgical Excisional Biopsy: Three-Year Experience of a Reference Center in Lebanon. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e455-e460. [PMID: 32461041 DOI: 10.1016/j.clml.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite current guidelines, a significant increase in the use of core needle biopsy (CNB) has been noted. Our aims were to determine the profile of patients referred for image-guided biopsies, to assess the diagnostic yield of these biopsies, and to learn whether CNB is an effective alternative to surgical excisional biopsy (SEB). PATIENTS AND METHODS All lymph node biopsy samples evaluated in the Department of Pathology and Laboratory Medicine from 2014 to 2017 were included. Patients' demographics, biopsy type, and final diagnosis were recorded and classified as diagnostic or nondiagnostic. The reasons for the latter were evaluated and follow-up was obtained, where available. RESULTS A total of 373 cases, 210 CNB and 163 SEB, were collected. The diagnostic yield was 79% for CNB compared to 97% for SEB. The choice of CNB versus SEB was not dependent on patient's age, gender, or clinical suspicion of malignancy. Failure to reach a diagnosis was due to insufficient or suboptimal tissue in most nondiagnostic CNBs. Lymphoma was equally diagnosed among CNB and SEB. CNB was at an advantage in diagnosing large B-cell lymphomas. CONCLUSION When performed adequately, CNB is a good substitute for SEB. Strict and specific guidelines need to be updated and adopted to indicate how and when it can be used, including the recommendation of concomitant complementary diagnostic laboratory testing such as flow cytometry. The latter should be readily available in order to not compromise the quality and accuracy of the diagnoses.
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Affiliation(s)
- Nada Assaf
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zaher Chakhachiro
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Campanelli M, Cabry F, Marasca R, Gelmini R. Peripheral lymphadenopathy: role of excisional biopsy in differential diagnosis based on a five-year experience. MINERVA CHIR 2019; 74:218-223. [DOI: 10.23736/s0026-4733.18.07752-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kwon M, Yim C, Baek HJ, Lee JS, Seo JH, Kim JP, Woo SH, Park JJ. Ultrasonography-guided core needle biopsy of cervical lymph nodes for diagnosing head and neck lymphoma compared with open surgical biopsy: Exploration for factors that shape diagnostic yield. Am J Otolaryngol 2018; 39:679-684. [PMID: 30055795 DOI: 10.1016/j.amjoto.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study was conducted to compare the diagnostic yields of Ultrasonography-guided core needle biopsy (USG-CNB) and open surgical biopsy (OSB) in head and neck (HN) lymphoma and to identify the factors that shape USG-CNB diagnostic yield. MATERIALS AND METHODS All consecutive patients who were diagnosed with HN lymphoma in our hospital were analyzed. The frequencies with which these first-line procedures yielded a sample that permitted histological confirmation of lymphoma were determined. To identify the factors that shape the diagnostic yield of USG-CNB, the patients in whom USG-CNB was and was not sufficiently confirmatory were compared in terms of demographics, computed tomography (CT) and pathological findings. RESULTS In total, 83 patients underwent USG-CNB (n = 26, 31.3%) or OSB (n = 57, 68.7%) for confirming lymphoma. USG-CNB yielded a fully sufficient diagnosis in 18 (69.2%) patients. By contrast, OSB yielded a confirmative diagnosis in 56 (98.2%) patients. Maximal standardized uptake value (SUVmax) of targeted LN on positron emission tomography-CT (PET-CT) in confirmatively diagnosed subjects was much higher than deferred counterparts (22.9 ± 13.4 vs. 10.1 ± 5.2, p = 0.017), however, there was no significant difference in other parameters associated with the first-line USG-CNB diagnostic success. CONCLUSIONS First-line USG-CNB was less frequently successful than OSB for diagnosing HN lymphoma involving cervical LN. Mean SUVmax of LN on PET-CT in confirmatively diagnosed subjects was higher than deferred counterparts on USG-CNB.
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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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Efficacy of ultrasound-guided core needle biopsy in cervical lymphadenopathy: A retrospective study of 6,695 cases. Eur Radiol 2017; 28:1809-1817. [DOI: 10.1007/s00330-017-5116-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/26/2022]
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30
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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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Shah HJ, Keraliya AR, Jagannathan JP, Tirumani SH, Lele VR, DiPiro PJ. Diffuse Large B-Cell Lymphoma in the Era of Precision Oncology: How Imaging Is Helpful. Korean J Radiol 2017; 18:54-70. [PMID: 28096718 PMCID: PMC5240489 DOI: 10.3348/kjr.2017.18.1.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common histological subtype of Non-Hodgkin's lymphoma. As treatments continues to evolve, so do imaging strategies, and positron emission tomography (PET) has emerged as the most important imaging tool to guide oncologists in the diagnosis, staging, response assessment, relapse/recurrence detection,and therapeutic decision making of DLBCL. Other imaging modalities including magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, and conventional radiography are also used in the evaluation of lymphoma. MRI is useful for nervous system and musculoskeletal system involvement and is emerging as a radiation free alternative to PET/CT. This article provides a comprehensive review of both the functional and morphological imaging modalities, available in the management of DLBCL.
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Affiliation(s)
- Hina J Shah
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abhishek R Keraliya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jyothi P Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Vikram R Lele
- Department of Nuclear Medicine and PET/CT, Jaslok Hospital and Research Centre, Mumbai 400026, India
| | - Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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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: 43] [Impact Index Per Article: 5.4] [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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Haldar S, Sinnott JD, Tekeli KM, Turner SS, Howlett DC. Biopsy of parotid masses: Review of current techniques. World J Radiol 2016; 8:501-505. [PMID: 27247715 PMCID: PMC4882406 DOI: 10.4329/wjr.v8.i5.501] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/31/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology (FNAC) or ultrasound guided core biopsy (USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section (IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.
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Groneck L, Quaas A, Hallek M, Zander T, Weihrauch MR. Ultrasound-guided core needle biopsies for workup of lymphadenopathy and lymphoma. Eur J Haematol 2016; 97:379-86. [DOI: 10.1111/ejh.12742] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Groneck
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
| | - Alexander Quaas
- Institut für Pathologie; Universitätsklinik Köln; Köln Germany
| | - Michael Hallek
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
- Centrum für Integrierte Onkologie CIO Köln; Köln Germany
| | - Thomas Zander
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
- Centrum für Integrierte Onkologie CIO Köln; Köln Germany
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Learned KO, Lev-Toaff AS, Brake BJ, Wu RI, Langer JE, Loevner LA. US-guided Biopsy of Neck Lesions: The Head and Neck Neuroradiologist’s Perspective. Radiographics 2016; 36:226-43. [DOI: 10.1148/rg.2016150087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen CN, Lin CY, Chi FH, Chou CH, Hsu YC, Kuo YL, Lin CF, Chen TC, Wang CP, Lou PJ, Ko JY, Hsiao TY, Yang TL. Application of Ultrasound-Guided Core Biopsy to Minimal-Invasively Diagnose Supraclavicular Fossa Tumors and Minimize the Requirement of Invasive Diagnostic Surgery. Medicine (Baltimore) 2016; 95:e2172. [PMID: 26825877 PMCID: PMC5291547 DOI: 10.1097/md.0000000000002172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tumors of the supraclavicular fossa (SC) is clinically challenging because of anatomical complexity and tumor pathological diversity. Because of varied diseases entities and treatment choices of SC tumors, making the accurate decision among numerous differential diagnoses is imperative. Sampling by open biopsy (OB) remains the standard procedure for pathological confirmation. However, complicated anatomical structures of SC always render surgical intervention difficult to perform. Ultrasound-guided core biopsy (USCB) is a minimally invasive and office-based procedure for tissue sampling widely applied in many diseases of head and neck. This study aims to evaluate the clinical efficacy and utility of using USCB as the sampling method of SC tumors. From 2009 to 2014, consecutive patients who presented clinical symptoms and signs of supraclavicular tumors and were scheduled to receive sampling procedures for diagnostic confirmation were recruited. The patients received USCB or OB respectively in the initial tissue sampling. The accurate diagnostic rate based on pathological results was 90.2% for USCB, and 93.6% for OB. No significant difference was noted between USCB and OB groups in terms of diagnostic accuracy and the percentage of inadequate specimens. All cases in the USCB group had the sampling procedure completed within 10 minutes, but not in the OB group. No scars larger than 1 cm were found in USCB. Only patients in the OB groups had the need to receive general anesthesia and hospitalization and had scars postoperatively. Accordingly, USCB can serve as the first-line sampling tool for SC tumors with high diagnostic accuracy, minimal invasiveness, and low medical cost.
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Affiliation(s)
- Chun-Nan Chen
- From the Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (CN-C, CY-L, CH-C, YC-H, YL-K, CH-L, TC-C, CP-W, PJ-L, JY-K, TY-H, TL-Y); Department of Otolaryngology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (CN-C, YC-H, YL-K); Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan (CN-C, CY-L); Department of Otolaryngology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan (CY-L, FH-C, CH-C); and Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan (TL-Y)
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López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, Hartl DM, Bradley PJ, Mendenhall WM, Suárez C, Takes RP, Hamoir M, Robbins KT, Shaha AR, Werner JA, Rinaldo A, Ferlito A. Cervical lymph node metastases from remote primary tumor sites. Head Neck 2015; 38 Suppl 1:E2374-85. [PMID: 26713674 DOI: 10.1002/hed.24344] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/14/2015] [Accepted: 10/17/2015] [Indexed: 11/08/2022] Open
Abstract
Although most malignant lymphadenopathy in the neck represent lymphomas or metastases from head and neck primary tumors, occasionally, metastatic disease from remote, usually infraclavicular, sites presents as cervical lymphadenopathy with or without an obvious primary tumor. In general, these tumors metastasize to supraclavicular lymph nodes, but occasionally may present at an isolated higher neck level. A search for the primary tumor includes information gained by histology, immunohistochemistry, and evaluation of molecular markers that may be unique to the primary tumor site. In addition, 18F-fluoro-2-deoxyglocose positron emission tomography combined with CT (FDG-PET/CT) has greatly improved the ability to detect the location of an unknown primary tumor, particularly when in a remote location. Although cervical metastatic disease from a remote primary site is often incurable, there are situations in which meaningful survival can be achieved with appropriate local treatment. Management is quite complex and requires a truly multidisciplinary approach. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2374-E2385, 2016.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Carl E Silver
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Missak Haigentz
- Departments of Medicine (Oncology) and Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Justin A Bishop
- Departments of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Patrick J Bradley
- Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham, United Kingdom
| | | | - Carlos Suárez
- University of Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jochen A Werner
- Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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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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Skelton E, Jewison A, Okpaluba C, Sallomi J, Lowe J, Ramesar K, Grace R, Howlett D. Image-guided core needle biopsy in the diagnosis of malignant lymphoma. Eur J Surg Oncol 2015; 41:852-8. [DOI: 10.1016/j.ejso.2015.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/31/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022] Open
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Albasri AM, El-Siddig AA, Hussainy AS, Alhujaily AS. Pattern of lymph node pathology in western Saudi Arabia. Asian Pac J Cancer Prev 2015; 15:4677-81. [PMID: 24969903 DOI: 10.7314/apjcp.2014.15.11.4677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to characterize the histopathological pattern of lymph node pathology among Saudi patients and to highlight the age and gender variations of these lesions as base line data. MATERIALS AND METHODS We retrospectively analyzed the data from lymph node biopsy specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. RESULTS Of the 289 lymph node biopsy specimens received, 154 (53.3%) were from males and 135 (46.7%) from females giving a male: female ratio of 1.14:1. Age of the patients ranged from 2.5 to 96 years with a mean age 33.9 years. The commonest lymph node group affected was the cervical (30.4%) followed by axillary (9.7%) and inguinal (8.7%). Malignant lymphoma [71 Hodgkin's disease (HD), 57 non Hodgkin's lymphoma (NHL)] 128 (44.3%), reactive hyperplasia 68 (23.5%), and tuberculosis 41 (14.2%) were the common causes of lymph node enlargement. While HD, reactive hyperplasia and tuberculosis were commonest in young adult patients (10-29 years old) and rare above the age of 50 years; NHL was the predominant cause of lymph node enlargement above 50 years. CONCLUSIONS Lymph node biopsy plays an important role in establishing the cause of lymphadenopathy. Among the biopsied nodes, lymphomas were the most common (44.3%) followed by non-specific reactive hyperplasia (23.5%) and tuberculous lymphadenitis (14.2%).
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Frederiksen JK, Sharma M, Casulo C, Burack WR. Systematic review of the effectiveness of fine-needle aspiration and/or core needle biopsy for subclassifying lymphoma. Arch Pathol Lab Med 2015; 139:245-51. [PMID: 25611108 DOI: 10.5858/arpa.2013-0674-ra] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The World Health Organization system for lymphoma classification relies on histologic findings from excisional biopsies. In contradistinction to expert guidelines, practitioners increasingly rely on fine-needle aspiration cytology and core needle biopsies rather than excisional biopsies to diagnose lymphomas. OBJECTIVE To determine a rate at which fine-needle aspiration cytology and core needle biopsies, combined with flow cytometry and/or genetic techniques, can provide a diagnosis sufficient for optimal medical management of lymphoma. DATA SOURCES The English-language literature on fine-needle aspiration cytology and core needle biopsies for lymphoma was reviewed to identify studies that provided interpretations of all specimens regardless of whether these were deemed diagnostic. CONCLUSIONS Forty-two studies (1989-2012) specified the lymphoma subtypes for each diagnosis or indicated a rate at which the methods failed to provide a diagnosis. The median rate at which fine-needle aspiration cytology and core needle biopsies yielded a subtype-specific diagnosis of lymphoma was 74%. Strictly adhering to expert guidelines, which state that follicular lymphoma cannot be graded by these techniques, decreased the diagnostic yield further to 66%. Thus, 25% to 35% of fine-needle aspirates and/or core biopsies of nodes must be followed by an excisional lymph node biopsy to fully classify lymphoma.
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Affiliation(s)
- John K Frederiksen
- From the Department of Pathology and Laboratory Medicine (Drs Frederiksen, Sharma, and Burack) and the Division of Hematology and Oncology, Department of Medicine (Dr Casulo), University of Rochester Medical Center, Rochester, New York. Dr Frederiksen is now with the Department of Pathology, University of Michigan, Ann Arbor
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Lubek JE, Shihabi A, Murphy LA, Berman JN. Hematopoietic neck lesions. Atlas Oral Maxillofac Surg Clin North Am 2015; 23:31-7. [PMID: 25707563 DOI: 10.1016/j.cxom.2014.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Joshua E Lubek
- Oral-Head Neck Surgery/Microvascular Surgery, Oncology Program, Greenebaum Cancer Center, University of Maryland, 650 West Baltimore Street, Room 1401, Baltimore, MD 21201, USA.
| | - Amro Shihabi
- Oral-Head Neck Surgery/Microvascular Surgery, Oncology Program, Greenebaum Cancer Center, University of Maryland, 650 West Baltimore Street, Room 1401, Baltimore, MD 21201, USA
| | - Laura A Murphy
- Department of Pediatrics, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada
| | - Jason N Berman
- Department of Pediatrics, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada; Clinician Investigator Program and Clinician Scientist Graduate Program, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada; Division of Hematology/Oncology, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada; Department of Microbiology and Immunology, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada; Department of Pathology, IWK Health Centre, Dalhousie University, 1348 Summer Street, Halifax, Nova Scotia B3H 4R2, Canada
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Eom HJ, Lee JH, Ko MS, Choi YJ, Yoon RG, Cho KJ, Nam SY, Baek JH. Comparison of fine-needle aspiration and core needle biopsy under ultrasonographic guidance for detecting malignancy and for the tissue-specific diagnosis of salivary gland tumors. AJNR Am J Neuroradiol 2015; 36:1188-93. [PMID: 25678480 DOI: 10.3174/ajnr.a4247] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Diagnostic test accuracy studies for ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy have shown inconclusive results due to their heterogenous study designs. Our aim was to compare the diagnostic accuracy of ultrasonography-guided fine-needle aspiration versus ultrasonography-guided core needle biopsy for detecting malignant tumors of the salivary gland and for the tissue-specific diagnosis of salivary gland tumors in a single tertiary hospital. MATERIALS AND METHODS This retrospective study was approved by our institutional review board and informed consent was waived. Four hundred twelve patients who underwent ultrasonography-guided fine-needle aspiration (n = 155) or ultrasonography-guided core needle biopsy (n = 257) with subsequent surgical confirmation or clinical follow-up were enrolled. We compared the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy regarding malignant salivary gland tumors and the correct tissue-specific diagnosis of benign and malignant tumors. We also tested the difference between these procedures according to the operator's experience and lesion characteristics. RESULTS The inconclusive rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 19% and 4%, respectively (P < .001). The overall accuracy of ultrasonography-guided core needle biopsy for diagnosing malignant tumors was significantly higher than that of ultrasonography-guided fine-needle aspiration (P = .024). The correct tissue-specific diagnosis rates of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy were 95% versus 97% for benign tumors (P = .648) and 67% versus 80% for malignant tumors (P = .310). Trainees showed significantly lower accuracy with ultrasonography-guided fine-needle aspiration than with ultrasonography-guided core needle biopsy for diagnosing malignant tumors (P = .021). There was no difference between the diagnostic accuracy of ultrasonography-guided fine-needle aspiration and ultrasonography-guided core needle biopsy according to the internal composition of the lesions. There were no complications requiring intervention or hospitalization in our patients. CONCLUSIONS Ultrasonography-guided core needle biopsy is superior to ultrasonography-guided fine-needle aspiration in detecting and characterizing malignant tumors of the salivary gland and could emerge as the diagnostic method of choice for patients presenting with a salivary gland mass.
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Affiliation(s)
- H-J Eom
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - M-S Ko
- Departments of Health Medicine (M.-S.K.)
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | - R G Yoon
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
| | | | - S Y Nam
- Otolaryngology (S.Y.N.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology (H.-J.E., J.H.L., Y.J.C., R.G.Y., J.H.B.)
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Core needle biopsy is a safe and accurate initial diagnostic procedure for suspected lymphoma. Am J Surg 2014; 208:1003-8; discussion 1007-8. [DOI: 10.1016/j.amjsurg.2014.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 11/22/2022]
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Haldar S, Mandalia U, Skelton E, Chow V, Turner SS, Ramesar K, Tighe D, Williams M, Howlett D. Diagnostic investigation of parotid neoplasms: a 16-year experience of freehand fine needle aspiration cytology and ultrasound-guided core needle biopsy. Int J Oral Maxillofac Surg 2014; 44:151-7. [PMID: 25457828 DOI: 10.1016/j.ijom.2014.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/25/2014] [Accepted: 09/30/2014] [Indexed: 01/12/2023]
Abstract
This study aimed to examine the diagnostic yield of fine needle aspiration cytology (FNAC) and ultrasound-guided core needle biopsy (USCB) in the diagnosis of parotid neoplasia. A 16-year retrospective analysis was performed of patients entered into our pathology database with a final diagnosis of parotid neoplasia. FNAC and USCB data were compared to surgical excision where available. One hundred and twenty FNAC, 313 USCB, and 259 surgical specimens were analyzed from 397 patients. Fifty-six percent of FNAC and 4% of USCB were non-diagnostic. One hundred and thirty-two (33%) patients had a final diagnosis made by USCB and did not undergo surgery. Surgery was performed in 257 (65%) patients, 226 (88%) of whom had a preoperative biopsy. Most lesions were benign, but there were 62 parotid and 13 haematological malignancies diagnosed; false-negative results were obtained in three FNAC and two USCB samples. The sensitivity and specificity of FNAC were 70% and 89%, respectively, and for USCB were 93% and 100%, respectively. This study represents the largest series of patients with a parotid neoplasm undergoing USCB for diagnosis. USCB is highly accurate with a low non-diagnostic rate and should be considered an integral part of parotid assessment.
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Affiliation(s)
- S Haldar
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK.
| | - U Mandalia
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - E Skelton
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - V Chow
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - S S Turner
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - K Ramesar
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - D Tighe
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - M Williams
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
| | - D Howlett
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK
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Madero-Visbal R, Milas Z. The role of parotidectomy in Sjögren's syndrome. Oral Maxillofac Surg Clin North Am 2014; 26:83-90. [PMID: 24287196 DOI: 10.1016/j.coms.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sjögren's syndrome, a chronic and progressive autoimmune disorder mainly characterized by xerophthalmia, xerostomia, and parotid enlargement, is primarily managed medically, but some patients will require surgical management. Patients with Sjögren's syndrome have an increased risk of non-Hodgkin lymphoma. Superficial parotidectomy is indicated for diagnostic purposes and can be therapeutic in limited circumstances. Surgical indications for parotidectomy in Sjögren's syndrome include recurrent parotitis refractory to medical management; salivary gland malignancy; and severe, refractory pain. Surgical complications include transient or permanent facial nerve injury, post-operative pain, persistent inflammation of remnant parotid tissue, Frey syndrome, and facial scarring.
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Affiliation(s)
- Rafael Madero-Visbal
- MD Anderson Cancer Center, Orlando, 1400 S Orange Avenue, Orlando, FL 32806, USA
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Lin CM, Lin CY. Pediatric Cervical Hodgkin's Lymphoma Diagnosed by Ultrasound-guided Core Needle Biopsy. J Med Ultrasound 2014. [DOI: 10.1016/j.jmu.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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48
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49
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Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. IRANIAN JOURNAL OF MEDICAL SCIENCES 2014; 39:158-70. [PMID: 24753638 PMCID: PMC3993046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/25/2013] [Accepted: 08/04/2013] [Indexed: 11/09/2022]
Abstract
Peripheral lymph nodes, located deep in the subcutaneous tissue, clean antigens from the extracellular fluid. Generally, a normal sized lymph node is less than one cm in diameter. Peripheral lymphadenopathy (LAP) is frequently due to a local or systemic, benign, self-limited, infectious disease. However, it could be a manifestation of underlying malignancy. Seventy-five percent of all LAPs are localized, with more than 50% being seen in the head and neck area. LAP may be localized or generalized. Cervical lymph nodes are involved more often than the other lymphatic regions. Generally, it is due to infections, but most of the supraclavicular lymphadenopathies are associated with malignancy. Based on different geographical areas, the etiology is various. For example, in tropical areas, tuberculosis (TB) is a main benign cause of LAP in adults and children. Complete history taking and physical examination are mandatory for diagnosis; however, laboratory tests, imaging diagnostic methods, and tissue samplings are the next steps. Tissue diagnosis by fine needle aspiration biopsy or excisional biopsy is the gold standard evaluation for LAP. We concluded that in patients with peripheral LAP, the patient's age and environmental exposures along with a careful history taking and physical examination can help the physician to request step by step further work-up when required, including laboratory tests, imaging modalities, and tissue diagnosis, to reach an appropriate diagnosis.
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Affiliation(s)
- Shahrzad Mohseni
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
| | - Abolfazl Shojaiefard
- Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhamak Khorgami
- Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Alinejad
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
| | - Ali Ghorbani
- Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghafouri
- Research Center for Improvement of Surgical Outcomes and Procedures, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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50
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Slaisova R, Benda K, Jarkovsky J, Petrasova H, Szturz P, Valek V. Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol 2013; 82:693-8. [DOI: 10.1016/j.ejrad.2012.12.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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