CT-guided needle biopsy performed with modified coaxial technique in patients with refractory or recurrent lymphomas

Sensitivity of core needle biopsy in the diagnosis of lymphoma: A meta-analysis

OBJECTIVE

Lymphoma commonly presents in the head and neck. Studies on the sensitivity of core needle biopsy (CNB) in diagnosing subtypes of lymphoma are mixed. We performed a meta-analysis of the existing literature to uncover the sensitivity of CNB in diagnosing lymphoma subtypes.

DATA SOURCES

PubMed, Embase by Elsevier REVIEW METHODS: Articles included examined the sensitivity of CNB by lymphoma subtype. We excluded articles that did not use CNB and lacked sufficient data. A random effect logistic regression model was used to pool sensitivity data. Pooled sensitivity estimates and corresponding 95 % confidence intervals were obtained from model estimates and all analyses were conducted at a significance of 0.05.

RESULTS

Screening yielded 32 articles (15 including Head and Neck nodes) with 3,027 biopsies. Across all subtypes, estimated sensitivity was 86.4 % (CI:76.1-96.7). There was significant heterogeneity among disease subtypes (p < 0.001). Chronic Lymphocytic Leukemia (CLL), Mantle Cell (MCL) and Diffuse Large B Cell (DLBCL) lymphoma exhibited highest sensitivities at 97.8 % (CI:94.2-99.1), 97.0 % (CI:92.2-98.9), and 94.5 % (CI:91.44-96.5), respectively. Low Grade B Cell not otherwise specified, Natural Killer/T cell, and Angioimmunoblastic Lymphomas demonstrated lowest sensitivities at 71.0 % (CI:44.5-88.2), 75.4 % (CI:23.0-96.9), and 77.1 % (CI:54.2-90.5), respectively.

CONCLUSION

CNB is highly sensitive in the diagnosis of some lymphoma subtypes, particularly MCL, DLBCL and CLL. Knowledge of CNB performance relative to each subtype can aid in clinical decision making, as it pertains to treatment and the need for excisional biopsy.

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

Purpose

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

Materials and methods

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

Results

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

Conclusion

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

Practice and prospects for PET/CT guided interventions

During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.

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

Introduction

Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. Nevertheless, it requires hospitalization, availability of an operating room, and sometimes general anesthesia, and it is associated with several drawbacks. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be potentially used to drive biopsy to the most metabolically active area within a lymph node or extranodal masses.

Methods

A study of diagnostic accuracy was conducted to assess the performance of a PET-driven needle biopsy in patients with suspect active lymphoma.

Results

Overall, 99 procedures have been performed: three (3.0%) were interrupted because of pain but were successfully repeated in two cases. Median SUVmax of target lesions was 10.7. In 84/96 cases, the tissue was considered adequate to formulate a diagnosis (diagnostic yield of 87.5%) and to guide the following clinical decision. The target specimen was a lymph node in 60 cases and an extranodal site in 36. No serious adverse events occurred. The sensitivity of this procedure was 96%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 75%.

Conclusion

Patients can benefit from a minimally invasive procedure which allows a timely and accurate diagnosis of lymphoma at onset or relapse.

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

Background

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

Methods

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

Results

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

Conclusions

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