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Fitzpatrick MJ, Sohani AR, Ly A. Uses and limitations of small-volume biopsies for the diagnosis of lymphoma. Cytopathology 2024; 35:454-463. [PMID: 38462899 DOI: 10.1111/cyt.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small-volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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2
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Picardi M, Giordano C, Vigliar E, Zeppa P, Cozzolino I, Pugliese N, Della Pepa R, Esposito M, Abagnale DP, Ciriello M, Muccioli-Casadei G, Troncone G, Russo D, Mascolo M, Varricchio S, Accarino R, Persico M, Pane F. Ultrasonography-guided core-needle biopsy of lymphadenopathies suspected of lymphoma: Analysis on diagnostic efficacy and safety of 1000 front-line biopsies in a multicenter Italian study. Hematol Oncol 2023; 41:817-827. [PMID: 37415412 DOI: 10.1002/hon.3204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
The reliability and safety of front-line ultrasonography guided core needle biopsy (UG-CNB) performed with specific uniform approach have never been evaluated in a large series of patients with lymphadenopathies suspected of lymphoma. The aim of this study was to assess the overall accuracy of UG-CNB in the lymph node histological diagnosis, using a standard reference based on pathologist consensus, molecular biology, and/or surgery. We retrospectively checked the findings concerning the application of lymph node UG-CNB from four Italian clinical units that routinely utilized 16-gauge diameter modified Menghini needle under power-Doppler ultrasonographic guidance. A data schedule was sent to all centers to investigate the information regarding techniques, results, and complications of lymph node UG-CNB in untreated patients over a 12-year period. Overall, 1000 (superficial target, n = 750; deep-seated target, n = 250) biopsies have been evaluated in 1000 patients; other 48 biopsies (4.5%), screened in the same period, were excluded because inadequate for a confident histological diagnosis. Most patients were suffering from lymphomas (aggressive B-cell non-Hodgkin lymphoma [aBc-NHL], 309 cases; indolent B-cell [iBc]-NHL, 279 cases; Hodgkin lymphoma [HL], 212 cases; and nodal peripheral T-cell [NPTC]-NHL, 30 cases) and 100 cases from metastatic carcinoma; 70 patients had non-malignant disorders. The majority of CNB results met at least one criterion of the composite reference standard. The overall accuracy of the micro-histological sampling was 97% (95% confidence interval: 95%-98%) for the series. The sensitivity of UG-CNB for the detection of aBc-NHL was 100%, for iBc-NHL 95%, for HL 93%, and for NPTC-NHL 90%, with an overall false negative rate of 3.3%. The complication rate was low (6% for all complications); no patient suffered from biopsy-related complications of grade >2 according to the Common Terminology Criteria for Adverse Events. Lymph node UG-CNB as mini-invasive diagnostic procedure is effective with minimal risk for the patient.
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Affiliation(s)
- Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, Federico II University Medical School, Naples, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, Salerno University Medical School, Baronissi, Italy
| | - Imma Cozzolino
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Maria Esposito
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Davide Pio Abagnale
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Mauro Ciriello
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Giada Muccioli-Casadei
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, Federico II University Medical School, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Rossella Accarino
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Marcello Persico
- Department of General Surgery, Endocrinology, Orthopaedics, and Rehabilitations, Federico II University Medical School, Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
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Pizzi M, Sbaraglia M, Dal Santo L, De Bartolo D, Santoro L, Scarmozzino F, Mussolin L, Pillon M, Piazza F, Trentin L, Dei Tos AP. Higher accuracy of surgical over core needle biopsy for the diagnosis of lymphoproliferative disorders. Int J Lab Hematol 2023. [PMID: 36871956 DOI: 10.1111/ijlh.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION The diagnosis of lymphoproliferative disorders (LPDs) is based on histological evaluation of representative tissue samples. Despite surgical excision biopsies (SEBs) are reference procedures for such diagnoses, lymph node core needle biopsies (LNCBs) are increasingly performed. The diagnostic yield of LNCB is, however, debated and few studies have compared the reproducibility of LNCB and SEB findings. METHODS To address the diagnostic value of LNCB and SEB, the present study considered a retrospective series of 43 paired LNCB/SEB samples. After histological revision, concordance rates between matched LNCB/SEB samples were evaluated, assuming SEB as gold standard procedure. The actionability of LNCB and SEB-based diagnoses (i.e., relevance for planning further medical interventions) was also assessed. RESULTS Overall, LNCB provided actionable diagnoses in 39/43 (90.7%) cases, but a consistent subset of them (7/39 [17.9%]) turned out to be wrong at SEB. The cumulative diagnostic inaccuracy of LNCB (i.e., inadequate samples plus wrong diagnoses) was 25.6% and the mean diagnostic delay in such cases was 54.2 days. CONCLUSIONS Although limited by selection biases due to its retrospective nature, this study highlights the intrinsic limitations of LNCB for the diagnosis of LPDs. SEB remains the gold standard procedure and should be performed in all suitable cases.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Luca Dal Santo
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Debora De Bartolo
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Luisa Santoro
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Federico Scarmozzino
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Lara Mussolin
- Oncohematology Unit, Department of Children and Women's Health, University of Padua School of Medicine, Padua, Italy
| | - Marta Pillon
- Oncohematology Unit, Department of Children and Women's Health, University of Padua School of Medicine, Padua, Italy
| | - Francesco Piazza
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Livio Trentin
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
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Incorporation of ultrasound-guided core biopsy with flow cytometry to assist the diagnosis of cervical lymphoma. Eur Arch Otorhinolaryngol 2023; 280:1437-1446. [PMID: 36322178 DOI: 10.1007/s00405-022-07705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The main purpose of surgery for cervical lymphoma is only for tissue sampling. To establish a patient-friendly diagnostic approach, we investigated the feasibility of ultrasound-guided core biopsy with flow cytometry in the patients with suspected cervical lymphoma. METHODS We prospectively recruited patients with suspected cervical lymphoma from Nov 2017 till Jan 2021 in a referral medical center and performed retrospective interpretation of the prospectively acquired data. Ultrasound-guided core biopsy as the tissue sampling approach for the targeted lesions was performed in all patients. The ultrasound-guided core biopsy samples were analyzed by immunohistochemical stains and flow cytometry. The sample quality and the rate of definite and decisive diagnosis obtained by ultrasound-guided core biopsy alone and ultrasound-guided core biopsy with flow cytometry were evaluated. RESULTS Total 81 consecutive patients were recruited for analysis. All ultrasound-guided core biopsy samples were qualified for analysis of pathology and flow cytometry. Pathologically, the diagnoses were definite and compatible with their flow cytometry results in 70 patients (86.42%). Either newly-diagnosed or recurrent cervical lymphoma/lymphoproliferative disorders with histologic transformation could be diagnosed by ultrasound-guided core biopsy with flow cytometry. Nine of the 11 patients with pathologically indefinite diagnosis became clinically decisive when flow cytometry was incorporated into the process, which improved the rate of decisive diagnosis to 98.77% (Odds ratio [95% CI]: 6.21 [1.28, 58.96]). CONCLUSION Ultrasound-guided core biopsy combined with flow cytometry is suggested to serve as the first-line and patient-friendly diagnostic approach for the patients with suspected cervical lymphoma.
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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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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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Picardi M, Giordano C, Della Pepa R, Pugliese N, Leone A, Mascolo M, Daniela R, Vigliar E, Troncone G, Salvatore C, Pane F. Correspondence in reference to the previously published Epub manuscript by Peter Hokland et al. 'How I treat advanced Hodgkin lymphoma - a global view'. Br J Haematol. 2020;190:837-50. Br J Haematol 2021; 193:e5-e8. [PMID: 33660274 DOI: 10.1111/bjh.17371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
| | - Aldo Leone
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Russo Daniela
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, Federico II University Medical School Naples, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, Federico II University Medical School Naples, Naples, Italy
| | | | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Unit, Federico II University Medical School, Naples, Italy
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Li J, Han J, Wang Y, Mo Y, Li J, Xiang J, Li Z, Zhou J, Wang S. Core Needle Biopsy Targeting the Viable Area of Deep-Sited Dominant Lesion Verified by Color Doppler and/or Contrast-Enhanced Ultrasound Contribute to the Actionable Diagnosis of the Patients Suspicious of Lymphoma. Front Oncol 2020; 10:500153. [PMID: 33117672 PMCID: PMC7577120 DOI: 10.3389/fonc.2020.500153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
Background Inadequate accuracy of ultrasound-guided core needle biopsy (US-CNB) urges further improvement for the diagnosis and management of lymphoma to meet with the practitioners’ increased reliance on this mini-invasive approach. Methods Data related to US-CNB of the deep-sited dominant lesions suspicious of lymphoma detected by computer tomography or positron-emission tomography/computer tomography for eligibility assessment of three prospective clinical trials were collected in advance. A retrospective analysis of the prospective data collection was performed, in which Viable-targeting US-CNB that Color Doppler flow imaging (CDFI) and/or contrast enhanced ultrasound (CEUS) were employed to select viable area for biopsy target compared with Routine US-CNB that routine procedure of evaluation and guidance using gray-scale ultrasound with CDFI in terms of the yield of clinically actionable diagnosis and safety, and determinants for the successful US-CNB that established an actionable diagnosis were explored. The establishment of final diagnosis was based on surgical pathology or medical response to therapy with follow-up at least 6 months. Results A total of 245 patients underwent Routine US-CNB (N = 120) or Viable-targeting US-CNB (N = 125), of which 91 (91/120, 75.8%) and 112 (112/125, 89.6%) were revealed with actionable diagnoses, respectively (p = 0.004, OR 0.846, 95% CI: 0.753–0.952). And 239 patients established final diagnoses. Diagnostic yields of actionable diagnosis according to the final diagnoses were 78.4% (91/116) and 91.1% (112/123) (p = 0.006, OR 0.554, 95% CI: 0.333–0.920), 82.6% (90/109) and 92.5% (111/120) for malignancy, 84.0% (84/100) and 91.8% (101/110) for lymphoma, 85.1% (80/94) and 92.3% (96/104) for Non-Hodgkin Lymphoma, 66.7% (4/6) and 83.3% (5/6) for Hodgkin Lymphoma in Routine and Viable-targeting CNB groups, respectively. No major complications were observed. Dominant lesions with actionable diagnosis in US-CNB were with higher FDG-avid Standardized Uptake Value. Binomial logistic regression revealed that actionable diagnosis of US-CNB was correlated with group and ancillary studies. Conclusion Viable-Targeting US-CNB was superior to routine US-CNB in term of the yield of actionable diagnosis for deep-sited dominant lesions suspicious of lymphoma, which demonstrated a potential to be the initial approach in this setting.
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Affiliation(s)
- Jian Li
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing Han
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunxian Mo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jin Xiang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiming Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jianhua Zhou
- Department of Diagnostic & Interventional Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Siyu Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Pugliese N, Di Perna M, Cozzolino I, Ciancia G, Pettinato G, Zeppa P, Varone V, Masone S, Cerchione C, Della Pepa R, Simeone L, Giordano C, Martinelli V, Salvatore C, Pane F, Picardi M. Randomized comparison of power Doppler ultrasonography-guided core-needle biopsy with open surgical biopsy for the characterization of lymphadenopathies in patients with suspected lymphoma. Ann Hematol 2017; 96:627-637. [PMID: 28130574 PMCID: PMC5334396 DOI: 10.1007/s00277-017-2926-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/16/2017] [Indexed: 12/22/2022]
Abstract
The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. We employed power Doppler ultrasonography (PDUS) to select the lymph node most suspected of malignancy and to histologically characterize it through the use of large cutting needle. Institutional review board approval and informed consent were obtained for this randomized clinical trial. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either standard surgery or PDUS-guided 16-gauge modified Menghini needle. The primary endpoint was the superiority of sensitivity for the diagnosis of malignancy for core-needle cutting biopsy (CNCB). Secondary endpoints were times to biopsy, complications, and costs. A total of 376 patients were randomized into the two arms and received allocated biopsy. However, four patients undergoing CNCB were excluded for inadequate samples; thus, 372 patients were analyzed. Sensitivity for the detection of malignancy was significantly better for PDUS-guided CNCB [98.8%; 95% confidence interval (CI), 95.9–99.9] than standard biopsy (88.7%; 95% CI, 82.9–93; P < 0.001). For all secondary endpoints, the comparison was significantly disadvantageous for conventional approach. In particular, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with CNCB. The presence of satellite enlarged reactive and/or necrotic lymph nodes may impair the success of an open surgical biopsy (OSB). PDUS and CNCB with adequate gauge are diagnostic tools that enable effective, safe, fast, and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention.
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Affiliation(s)
- Novella Pugliese
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy.
| | - M Di Perna
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - I Cozzolino
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - G Ciancia
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - G Pettinato
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - P Zeppa
- Department of Medicine and Surgery, University Medical School, Salerno, Salerno, Italy
| | - V Varone
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
| | - S Masone
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Cerchione
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - R Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - L Simeone
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Giordano
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - V Martinelli
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - C Salvatore
- Department of Economics, University of Molise, Campobasso, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Via S. Pansini 5, 80131, Naples, Italy
| | - M Picardi
- Department of Advanced Biomedical Sciences, Federico II University Medical School, Naples, Naples, Italy
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Abdulla M, Laszlo S, Triumf J, Hedström G, Berglund M, Enblad G, Amini RM. Core needle biopsies for the diagnosis of diffuse large B-cell lymphoma - a great concern for research. Acta Oncol 2017; 56:106-109. [PMID: 27796168 DOI: 10.1080/0284186x.2016.1245863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Maysaa Abdulla
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Sofia Laszlo
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Johanna Triumf
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Gustaf Hedström
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Mattias Berglund
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Novum, Huddinge, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Rose-Marie Amini
- Department of Immunology, Genetics and Pathology, Unit of Pathology, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
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Sensitivity of fine-needle aspiration biopsy for diagnosing and grading follicular lymphomas using a multiparameter approach in a cancer center. J Am Soc Cytopathol 2016; 6:80-88. [PMID: 31042638 DOI: 10.1016/j.jasc.2016.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The diagnosis and grading of follicular lymphomas (FLs) by fine-needle aspiration biopsy (FNAB) has not been systematically compared with core needle biopsy (CNB). We evaluated the sensitivity of FNAB in diagnosing and grading FLs using a multiparameter approach in a large cancer center. METHODS We retrospectively identified CNBs of lymph nodes diagnosed as FL that also had a concurrently acquired FNAB on the same site. The majority of cases had flow cytometric analysis and these results were available for interpretation of both the FNAB and CNB. RESULTS Out of 342 patients, CNB diagnoses included 291 (85%) low-grade (LG) FLs, 30 (9%) high-grade (HG) FLs, and 21 (6%) non-graded FLs/other. FNAB diagnoses included 194 (57%) LG FLs, 19 (6%) HG FLs, 93 (27%) non-graded FLs, 9 (3%) large B-cell lymphomas (LBCL) of follicle center origin, and 27 (7%) insufficient for diagnosis/other. Review of non-graded FLs showed 45% LG, 35% indeterminate due to polymorphous lymphoid cells with increased numbers of large cells, and 20% scant cellularity. Sensitivity of FNAB for diagnosing FL was 89%, and 66% for LG FL. The latter increased (94%), however, when grading was performed. CONCLUSION FNAB is highly sensitive for diagnosing FLs when cellular material for cytomorphology and flow cytometric analysis is obtained, and grading is feasible for most LG FLs. A subset of FLs composed of a polymorphous lymphoid population with increased numbers of large cells may be more difficult to grade, and HG FLs can be difficult to distinguish from CD10-positive diffuse LBCLs.
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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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