30 years of lymph node pathology: biomarkers and other advances

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.

Core Needle Biopsy in Lymphoma Diagnosis: The Diagnostic Performance and the Role of the Multidisciplinary Approach in the Optimization of Results

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.

Sensitivity of fine-needle aspiration biopsy for diagnosing and grading follicular lymphomas using a multiparameter approach in a cancer center

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.