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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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Jelloul FZ, Navarro M, Navale P, Hagan T, Cocker RS, Das K, Rosen L, Zhang X, Sheikh-Fayyaz S. Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience. Acta Cytol 2019; 63:198-205. [PMID: 30909285 DOI: 10.1159/000497252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/26/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective is to study the efficacy of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) in the diagnosis of lymphoma in a single institution. STUDY DESIGN We retrospectively reviewed 635 FNAB/CNB cases performed in our institution to rule out lymphoma during a 4-year period and collected the relevant clinical and pathological information for statistical analysis. RESULTS AND CONCLUSIONS This cohort comprised 275 males and 360 females, with a median age of 57 years. Among the 593 cases with adequate diagnostic materials for lymphoma work-up, 226 were positive for lymphoma, 286 were negative for lymphoma, and 81 were nondiagnostic. Each case had an FNAB, and 191 cases also underwent a CNB. The subclassification rate according to the WHO (2008) was 67% overall, 81% for the FNAB with CNB group, and 40% for the FNAB group. In the FNAB with CNB group, the subclassification rates for cases with and without a history of lymphoma were not significantly different. A definitive diagnosis of lymphoma relied on ancillary studies, but was not affected by location, or the needle gauge of CNB. Follow-up data revealed a high diagnostic accuracy of FNAB with CNB. In conclusion, the use of FNAB and CNB with ancillary studies is effective in providing a definitive diagnosis of lymphoma in our experience at the Northwell Health System.
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Affiliation(s)
- Fatima-Zahra Jelloul
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Maria Navarro
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Pooja Navale
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Tamla Hagan
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Rubina S Cocker
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Lisa Rosen
- The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Xinmin Zhang
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Silvat Sheikh-Fayyaz
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA,
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Drylewicz MR, Watkins MP, Shetty AS, Lin MF, Salter A, Bartlett NL, Middleton WD, Yano M. Formulating a Treatment Plan in Suspected Lymphoma: Ultrasound-Guided Core Needle Biopsy Versus Core Needle Biopsy and Fine-Needle Aspiration of Peripheral Lymph Nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:581-586. [PMID: 30043431 DOI: 10.1002/jum.14724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Image-guided tissue sampling in the workup of suspected lymphoma can be performed by core needle biopsy (CNB) or CNB with fine-needle aspiration (FNA). We compared the yield of clinically actionable diagnoses between these methods of tissue sampling. METHODS All ultrasound-guided percutaneous peripheral lymph node biopsies from 2010 to 2017 at a single institution were retrospectively reviewed for biopsy type (CNB versus CNB + FNA), prior diagnosis of lymphoma, size of the target lymph node, number of cores, length of core specimens, and pathologic diagnosis. Lymphoma and lymphoid tissue were included; metastatic disease and nonlymphoid tissue were excluded. An oncologist specializing in lymphoma independently determined whether an actionable diagnosis could be made with the pathologic results in the context of the patient's medical record. χ2 analyses and univariable/multivariable logistic regression models were used for statistical analyses. RESULTS Of 578 lymph node biopsies, 306 (53%) had a prior diagnosis of lymphoma; 273 (47%) were CNB, and 305 (53%) were CNB + FNA. There was no significant difference between biopsy types (CNB versus CNB + FNA) in the number of cores (median [25th, 75th percentiles], 3 [3, 4] versus 4 [3, 4]; P = .47) or total length of tissue (4.1 [2.5, 6.1] versus 3.7 [2.3, 6] cm; P = .09). There was no difference in obtaining an actionable diagnosis between biopsy types after controlling for a known history of lymphoma (P = .271) or after controlling for the number of core specimens (P = .826). CONCLUSIONS In cases of suspected lymphoma, CNB without FNA was sufficient to obtain an actionable diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | - Motoyo Yano
- Washington University, St Louis, Missouri, USA
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Chi PD, Freed NS, Wake L, Page C, Smith LM, Amador C, Qureishi HN, Greiner TC, Rodig SJ, Pirruccello SJ, Yuan J, Fu K. A Simple and Effective Method for Flow Cytometric Study of Lymphoid Malignancies Using Needle Core Biopsy Specimens. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018. [PMID: 29534323 DOI: 10.1002/cyto.b.21634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We developed a simple and effective rinsing technique (RT) of needle biopsies to produce cell suspensions for flow cytometry (FCM) and evaluated whether the RT is comparable to the conventional tissue cell suspension (TCS) technique. METHODS We retrieved 93 needle core biopsy cases employing the RT for FCM and 25 needle biopsy cases using TCS for FCM. RESULTS The diagnostic concordance between the FCM results and the morphologic diagnoses of both groups was compared. The diagnostic concordance was comparable in the RT group (92.6%) to the TCS group (71.4%). Furthermore, the diagnostic concordance in the RT group was associated with number of isolated cells. The diagnostic accuracy increased significantly when the cell number was above 30,000 in the RT group. CONCLUSIONS The RT for FCM not only maximizes the tissue utilization, but also is a simple and effective method to obtain cell suspension as compared to traditional cell suspension technique. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Pei-Dong Chi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China.,Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Natalie S Freed
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Laura Wake
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cynthia Page
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Catalina Amador
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hina Naushad Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Scott J Rodig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Pirruccello
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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Joudeh AA, Shareef SQ, Al-Abbadi MA. Fine-Needle Aspiration Followed by Core-Needle Biopsy in the Same Setting: Modifying Our Approach. Acta Cytol 2016; 60:1-13. [PMID: 26963594 DOI: 10.1159/000444386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 01/01/2023]
Abstract
Fine-needle aspiration biopsy (FNAB) is a well-established initial diagnostic tool. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis. Consequently, patients have to undergo another diagnostic procedure. The second procedure is either repeat FNAB, core-needle or open biopsy, and can be inconvenient and costly. In some centers, the FNAB is immediately followed by core-needle biopsy (CNB) in the same setting after assuring adequacy on the initial FNAB utilizing rapid on-site specimen evaluation (ROSE). It is argued that implementing such an approach will eventually have additional critical advantages that include the following: (a) it is more convenient to patients to have both procedures in one visit, (b) the tissue procured by both procedures will be more adequate, enabling cytopathologists to reach an accurate diagnosis, and (c) it is ultimately a cost-effective approach if we take into consideration the avoidance of a potential second more invasive diagnostic procedure. Since we are living in an era of patient-centered medicine coupled with cost-cutting strategies, we present here a brief review of the topic with analysis of this alternative approach, review of the pertinent literature and shed light on a few scenarios that justify this approach.
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Affiliation(s)
- Amani A Joudeh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
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Clinical application of ultrasound-guided core needle biopsy with multiple punches in the diagnosis of lymphoma. World J Surg Oncol 2015; 13:126. [PMID: 25885784 PMCID: PMC4383197 DOI: 10.1186/s12957-015-0537-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to investigate the feasibility, accuracy, and limitations of ultrasound (US)-guided core needle biopsy (CNB) with multiple punches in the diagnosis of lymphoma in the whole body. METHODS From March 2007 to October 2013, US-guided CNB with multiple punches was performed by well-experienced radiologists in 110 patients (CNB group), and surgical biopsy was carried out in 95 patients (surgical group). The differences of accuracy rate between the two groups in the diagnosis of lymphoma and its subtypes were examined with Fisher's exact test. RESULTS There were no statistical differences between the CNB group and the surgical group in the diagnostic accuracy rate of lymphoma, as well as its subtypes in superficial and deep masses. In addition, in the CNB group, there were no statistical differences between different lengths of lesions in the diagnosis accuracy rate of lymphoma and its subtypes. CONCLUSIONS US-guided CNB with no less than three punches is an accurate, safe, minimally invasive, non-radiological, fast, and cost-effective method in the evaluation of lymphoma and its subtypes as compared with surgical approach. It should be considered as the acceptable alternative to surgical biopsy to obtain histopathological samples in the patients with suspected lymphoma.
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Amador-Ortiz C, Chen L, Hassan A, Frater JL, Burack R, Nguyen TT, Kreisel F. Combined core needle biopsy and fine-needle aspiration with ancillary studies correlate highly with traditional techniques in the diagnosis of nodal-based lymphoma. Am J Clin Pathol 2011; 135:516-24. [PMID: 21411774 DOI: 10.1309/ajcp3wz8zdrjqdou] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Core needle biopsy (CNB) and fine-needle aspiration (FNA) are increasingly replacing excisional lymph node biopsy in the diagnosis of lymphomas. However, evaluation of CNB and FNA remains challenging owing to limited architectural information and the more detailed subclassification of lymphomas required by the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Our study is the largest study to assess diagnostic accuracy of CNB and FNA in conjunction with ancillary studies. We analyzed 263 cases and a diagnosis was established in 237, of which 193 were completely subclassified. In cases in which excisional biopsy was available as a reference for comparison, CNB and FNA had a sensitivity of 96.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 90%. CNB and FNA with ancillary studies represent a viable alternative in the diagnosis of lymphoma, as long as the number and size of cores for morphologic studies are not compromised.
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Burke C, Thomas R, Inglis C, Baldwin A, Ramesar K, Grace R, Howlett DC. Ultrasound-guided core biopsy in the diagnosis of lymphoma of the head and neck. A 9 year experience. Br J Radiol 2011; 84:727-32. [PMID: 21427181 DOI: 10.1259/bjr/60580076] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This retrospective study aimed to evaluate the diagnostic utility of ultrasound-guided core biopsy (USCB) in lymphoma of the head and neck, in particular whether core biopsy can provide sufficient diagnostic information for definitive treatment. METHODS All lymphomas diagnosed in the head and neck at Eastbourne General Hospital between January 2000 and June 2009 were identified. Radiology and pathology reports were reviewed and the diagnostic techniques recorded. The type of biopsy (fine needle aspiration, needle core, surgical excision biopsy) used to establish a diagnosis sufficient to allow treatment, i.e. the "index" diagnostic technique, was identified. Previous inconclusive or inadequate biopsies were noted. Pathology reports based on USCB were graded 0-3 according to diagnostic completeness and ability to provide treatment information. RESULTS Of 691 overall cases of lymphoma diagnosed over the 9 year period, 171 different patients presented with lymphoma in the head and neck. Of these 171, 83 had USCB biopsy during diagnostic work up. 60 were regarded as grade 3 where a confident diagnosis of lymphoma was made. In seven patients, clinical management proceeded on the basis of a suggestive (grade 2) pathology report without surgical excision, and these were therefore also included as "index" biopsies. Overall therefore, 67/83 core biopsies (81%) provided adequate information to allow treatment. Surgical excision biopsy was the index modality in 104 cases. CONCLUSION In the majority of cases USCB is adequate for confident histopathological diagnosis avoiding the need for surgical excision biopsy in cases of suspected head and neck lymphoma.
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Affiliation(s)
- C Burke
- Department of Radiology, Eastbourne District Hospital, East Sussex, UK.
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Pfeiffer J, Kayser G, Ridder GJ. Sonography-assisted cutting needle biopsy in the head and neck for the diagnosis of lymphoma: Can it replace lymph node extirpation? Laryngoscope 2009; 119:689-95. [DOI: 10.1002/lary.20110] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Diagnostic Yield of Computed Tomography-Guided Coaxial Core Biopsy of Undetermined Masses in the Free Retroperitoneal Space: Single-Center Experience. Cardiovasc Intervent Radiol 2008; 31:919-25. [DOI: 10.1007/s00270-008-9317-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 02/10/2008] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
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