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Pitot MA, Gu CN, Adamo DA, Kurup AN, Schmitz JJ, Packard AT. Safety and accuracy of aortic and periaortic CT-guided percutaneous core needle biopsy. Abdom Radiol (NY) 2023; 48:2148-2156. [PMID: 36939909 DOI: 10.1007/s00261-023-03867-4] [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: 12/17/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. MATERIALS AND METHODS A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. RESULTS 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. CONCLUSION CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.
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Affiliation(s)
- Marika A Pitot
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Chris N Gu
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Anil Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Annie T Packard
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Casaccia M, Testa T, Martigli SP, Santoliquido M, Lemoli RM. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac047. [PMID: 35280053 PMCID: PMC8906842 DOI: 10.1093/jscr/rjac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/06/2022] [Indexed: 11/16/2022] Open
Abstract
To date, there are no reports indicating the use of indocyanine green (ICG) fluorescence to detect pathologic lymphatic tissue when a laparoscopic lymph node biopsy (LLB) for suspected new or recurrent lymphoma is performed. We present the case of a 72-year-old female patient admitted for suspicion of recurrent lymphoma. A preoperative imaging work-up showed solid tissue enveloping the terminal portion of the abdominal aorta with a standardized uptake value (SUV) of 10. Therefore, an LLB was planned. After induction of anesthesia, a ICG solution was injected intravenously and subcutaneously at both inguinal regions. At laparoscopy, a complete visualization of the pathologic lymph nodes was achieved, enabling an incisional biopsy of the lymphomatous mass. LLB with ICG-fluorescence offers a simple and safe method for pathologic lymph node detection in the suspicion of intra-abdominal lymphoma. More studies with large case series are needed to confirm the efficacy of this application.
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Affiliation(s)
- Marco Casaccia
- Correspondence address. UOC Clinica Chirurgica 1, IRCCS Azienda Ospedaliera Universitaria San Martino–IST Monoblocco XI piano-Largo Rosanna Benzi, Genova 10 16132, Italia. Tel: +39-010-5554539; Fax: +39-010-5556944; E-mail:
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgery, San Martino Hospital, Genoa, Italy
| | - Sofia Paola Martigli
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Santoliquido
- Surgical Clinic Unit I, Department of Surgery, San Martino Hospital, Genoa, Italy
| | - Roberto Massimo Lemoli
- Department of Internal Medicine (DiMI), Clinic of Hematology, University of Genoa, Genoa, Italy
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Casaccia M, Fornaro R, Papadia FS, Testa T, Mascherini M, Ibatici A, Ghiggi C, Bregante S, De Cian F. Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy. JSLS 2021; 24:JSLS.2020.00045. [PMID: 33100817 PMCID: PMC7546779 DOI: 10.4293/jsls.2020.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution. Methods A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique. Results SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis. Conclusion SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Francesco Saverio Papadia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
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Ben-Ishay O. Laparoscopic dissection of the hepatic node: The trans lesser omentum approach. World J Gastrointest Oncol 2020; 12:77-82. [PMID: 31966915 PMCID: PMC6960073 DOI: 10.4251/wjgo.v12.i1.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/24/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis of lympho-proliferative diseases is sometimes challenging. Excisional lymph node biopsy is the standard of care. Five percent of the patients will present with abdominal or retroperitoneal lymphadenopathy alone. Advancements in endoscopic techniques allow for access to fine needle biopsy in complicated areas, but this often does not meet the standard guidelines for diagnosis.
AIM To investigate the results of laparoscopic excisional biopsy of the hepatic node (LEBHN) through a trans lesser omentum approach.
METHODS Data of all patients undergoing LEBHN were collected retrospectively from patients’ electronic charts over a period of 1 year. Data collected included age, gender, suspected disease, number of previous biopsies and biopsy method, surgical approach, intraoperative complications, operative time, post-operative complications, mortality, and final diagnosis.
RESULTS Six patients were operated in this technique during the time frame of the study, 66.6% (n = 4) were females, and median age was 55 years (range: 25-72 years). We present no conversions from laparoscopy to laparotomy, and mean operating time was 51.2 min. Mean length of hospital stay was 1 d, and morbidity and mortality were nil. Most importantly, this technique offered definite diagnosis and appropriate treatment in all patients. Final diagnosis included two patients with lymphoma (Hodgkin and Follicular), two patients with sarcoidosis, and two patients with reactive lymph nodes with no evidence of malignancy.
CONCLUSION In conclusion, this technique seems to be feasible and safe and may offer a simple approach for a definite diagnosis for what seems to be a complicated anatomical area.
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Affiliation(s)
- Offir Ben-Ishay
- Department of General Surgery, Rambam Health Care Campus, Haifa 35254, Israel
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Sando M, Terasaki M, Okamoto Y, Suzumura K, Tsuchiya T. The Utility of Diagnostic Laparoscopic Biopsy for Mesenteric and Retroperitoneal Lymph Nodes. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:878-882. [PMID: 28794405 PMCID: PMC5560472 DOI: 10.12659/ajcr.904444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ultrasound (US) or computed tomography (CT)-guided biopsy of intra-abdominal lymph nodes is minimally invasive; however, percutaneous procedures are often difficult to perform because of the location and size of the lymph nodes. In many cases, this approach may result in insufficient specimens necessary to evaluate histopathology. In such cases, laparoscopic biopsy is useful to obtain adequate specimens, regardless of the location and size of the lymph nodes. Additionally, laparoscopic biopsy is an approach that can avoid the possible complications associated with a laparotomy. CASE REPORT Between 2013 and 2016, a series of 11 patients underwent laparoscopic biopsy of mesenteric and retroperitoneal lymph nodes. All patients received a definitive histopathological diagnosis via laparoscopic biopsy. The median postoperative hospital stay was four days (range 3-13 days), and all patients were able to resume oral intake on postoperative day 1. No case was converted to laparotomy, and no major perioperative complication occurred, except for wound infection in one patient. CONCLUSIONS Diagnostic laparoscopic biopsy for mesenteric and retroperitoneal lymph nodes is safe and reliable.
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Affiliation(s)
- Masanori Sando
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Masaki Terasaki
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Yoshichika Okamoto
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Kiyoshi Suzumura
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Tomonori Tsuchiya
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
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Kawanishi H, Ito K, Kamido S, Kohno Y, Uemura T, Kato K, Uetsuki H, Ohno H, Okumura K. Advantage of urological experience with both transperitoneal and retroperitoneal laparoscopy in lymph node biopsy for malignant lymphoma diagnosis. Investig Clin Urol 2016; 57:401-407. [PMID: 27847913 PMCID: PMC5109797 DOI: 10.4111/icu.2016.57.6.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Laparoscopic urologists are familiar with both transperitoneal and retroperitoneal approaches. That experience is an advantage when devising a strategy for intra-abdominal lymph node biopsy. We report the feasibility and effectiveness of laparoscopic biopsy using a urological laparoscopic technique for the treatment of patients with clinically suspected intra-abdominal lymphoma. MATERIALS AND METHODS From October 2010 to April 2015, a total of 22 patients underwent laparoscopic biopsy for suspected intra-abdominal lymphoma. We adopted a retroperitoneal approach for paraaortic or paracaval masses, whereas we used a transperitoneal approach for mesenteric, iliac, or obturator masses. Whenever possible, an entire node was removed; otherwise, the biopsy consisted of wedge resection sized at least 1 cm3. RESULTS Biopsy specimens were obtained from the following lymph node sites: 10 paraaortic, 5 paracaval, 3 mesenteric, 2 obturator, 1 common iliac, and 1 perinephric fat. Laparoscopic lymph node biopsy was completed in all patients, and there were no conversions to open surgery. The median operating time was 97 minutes (range, 62-167 minutes). The estimated blood loss was <50 mL in all cases. Postoperatively, one patient (4.5%) had symptomatic chylous lymphocele that required surgical intervention. Precise diagnosis was established for all patients: malignant lymphoma in 20 patients and metastatic urothelial carcinoma and squamous cell carcinoma of unknown origin in 1 patient each. All lymphomas could be fully subclassified. CONCLUSIONS Appropriate use of the transperitoneal or retroperitoneal approach is safe and effective for laparoscopic lymph node biopsy in patients with suspected intra-abdominal lymphoma.
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Affiliation(s)
| | | | | | - Yuka Kohno
- Department of Urology, Tenri Hospital, Tenri, Japan
| | | | - Keiji Kato
- Department of Urology, Tenri Hospital, Tenri, Japan
| | | | - Hitoshi Ohno
- Department of Hematology, Tenri Hospital, Tenri, Japan
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Lewis S, Harber M, Fernando B, Banga N. Rapid and Early Diagnosis of Posttransplant Lymphoproliferative Disease Using Cross-Sectional Nuclear Medicine Imaging and Laparoscopic Lymph Node Biopsy: A Report of 2 Cases. EXP CLIN TRANSPLANT 2016; 15:470-473. [PMID: 26744227 DOI: 10.6002/ect.2015.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posttransplant lymphoproliferative disease is a complication of organ transplant with a myriad clinical and anatomic manifestations, thus making diagnosis difficult without histologic confirmation. In cases of lymphadenopathy confined to the abdomen, the diagnosis can be delayed because of late presentation and difficulty obtaining a tissue for histologic analyses. We describe the use of cross-sectional nuclear medicine imaging to locate enlarged abdominal lymph nodes; this facilitated minimally invasive laparoscopic lymph node excision biopsy to rapidly diagnose 2 cases of post-transplant lymphoproliferative disease. Prompt diagnosis has enabled early effective treatment, resulting in good patient outcomes.
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Affiliation(s)
- Sarah Lewis
- From the Royal Free London NHS Foundation Trust Renal Transplant Department, United Kingdom
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Abstract
A common indication for laparoscopic mesenteric lymph node biopsy is to provide a tissue diagnosis in the absence of palpable peripheral nodes via a minimally invasive approach. There are no reports to date of ischaemia to the appendix as a complication of this procedure. We report the case of a 34-year-old lady who underwent a mesenteric biopsy for a lesion found incidentally on CT to investigate longstanding abdominal pain, and 2 days later required an appendicectomy for ischaemic appendicitis.
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Affiliation(s)
| | - June Tun
- Department of General Surgery, Ipswich Hospital, Ipswich, IP4 5PD, UK
| | - Shashank Desai
- Department of General Surgery, Ipswich Hospital, Ipswich, IP4 5PD, UK
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Daly SC, Klairmont M, Arslan B, Vigneswaran Y, Roggin KF, Ujiki MB, Denham W, Millikan KW, Luu MB, Deziel DJ, Myers JA. Laparoscopy has a superior diagnostic yield than percutaneous image-guided biopsy for suspected intra-abdominal lymphoma. Surg Endosc 2014; 29:2496-9. [PMID: 25492451 DOI: 10.1007/s00464-014-4004-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 10/25/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION To date, no study has compared laparoscopy (LB) to percutaneous (PB) biopsy for the diagnosis of abdominal lymphoma. The objective of this study is to compare the success rate and safety profile of laparoscopic lymph node biopsy to the percutaneous approach in patients with intra-abdominal lymphadenopathy concerning for lymphoma. MATERIALS AND METHODS We performed a multi-institution, retrospective review of patients undergoing lymph node biopsy for suspected intra-abdominal lymphoma between 2005 and 2013. Our primary outcome was adequate tissue yield between the two techniques, both for histologic diagnosis and for ancillary studies such as flow cytometry. Secondary outcomes included 30-day morbidity, 30-day readmission rates, the need for additional lymph node biopsy procedures, and length of stay. RESULTS All 34 of the LB patients had adequate specimen for histologic diagnosis compared to 92.3% of patients with a PB (p = 0.18). Significantly more patients in the LB group had sufficient tissue for ancillary studies when needed than in the PB group, 95.5 and 68.2%, respectively (p = 0.04). A second biopsy was pursued in 23.1% of failed PB patients, 0% with success on second attempt. DISCUSSION When index of suspicion is high or when biopsy is performed for patient previously diagnosed with lymphoma and recurrence/transformation is suspected, LB safely and consistently provides adequate tissue for initial diagnosis and for ancillary studies. In contrast, image-guided PB may be more appropriate for patients for whom ancillary studies are unlikely to add to planned treatments or when there is a high risk of complications from either general anesthesia or patient comorbidities.
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Affiliation(s)
- Shaun C Daly
- Rush University Medical Center, Chicago, IL, USA,
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Tuberculous lymphadenopathy mimicking pancreatic neoplasm. Case Rep Med 2012; 2012:579297. [PMID: 22851977 PMCID: PMC3407625 DOI: 10.1155/2012/579297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 02/03/2023] Open
Abstract
Abdominal tuberculosis (TB) is the sixth most common location of extrapulmonary TB involvement. Because its symptoms and signs are often nonspecific, laboratory and imaging findings mimic other diseases including carcinoma. Therefore, the diagnosis of abdominal TB is challenging. We herein report a case of 74-year-old woman who presented with abdominal pain, anorexia, and weight loss. She had been given a diagnosis of pancreatic head carcinoma. Laboratory data was unremarkable except for elevated erythrocyte sedimentation rate, CA125, and sIL-2R. CT scan revealed multiple enlarged peripancreatic lymph nodes and concentric thickening of the ileocecal wall. Colonoscopy demonstrated deformed ileocecal valve and erosions. Histological examination showed epithelioid granulomas. Laparoscopy revealed numerous white tubercles diffusely covering the parietal peritoneum. Histopathological images of peripancreatic lymph node revealed large multiple caseating granulomas surrounded by Langhans_giant cells and epithelioid cells. Polymerase chain reaction and culture of the specimens were positive for Mycobacterium tuberculosis. Tuberculous lymphadenopathy, colitis, and peritonitis were finally diagnosed. She responded well to the antitubercular treatment.
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Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, Marcus R, Parameshwar J, Ramsay A, Newstead C. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol 2010; 149:675-92. [PMID: 20408847 DOI: 10.1111/j.1365-2141.2010.08161.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Transplantation Society (BTS) has reviewed the available literature and made recommendations for the diagnosis and management of post-transplant lymphoproliferative disorder (PTLD) in adult recipients of solid organ transplants. This review details the risk factors predisposing to development, initial features and diagnosis. It is important that the risk of developing PTLD is considered when using post transplant immunosuppression and that the appropriate investigations are carried out when there are suspicions of the diagnosis. These must include tissue for histology and computed tomography scan to assess the extent of disease. These recommendations have been made primarily for adult patients, there have been some comments made with regard to paediatric practice.
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Affiliation(s)
- Anne Parker
- The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
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Kim H, Hyung WJ, Lim JS, Park MS, Choi JY, Chung YE, Kim MJ, Kim KW. Laparoscopic ultrasonography-assisted retroperitoneal lymph node sampling in patients evaluated for stomach cancer recurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1229-1233. [PMID: 18645082 DOI: 10.7863/jum.2008.27.8.1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The precise localization of target lymph nodes during laparoscopic biopsy can often be technically challenging. The purpose of this series was to report 2 patients who successfully underwent laparoscopic para-aortic lymph node sampling with the assistance of laparoscopic ultrasonography (LUS). METHODS We describe 2 patients previously treated for gastric cancer who later had suspicious retroperitoneal lymphadenopathy detected by computed tomography. They received LUS-assisted lymph node biopsies for histologic evaluation. RESULTS Laparoscopic ultrasonography precisely localized the target lymph nodes, which measured 1.4 and 1.5 cm, respectively, in both patients. A transperitoneal laparoscopic approach and target lymph node sampling were successfully performed. No procedure-related technical difficulties or immediate complications occurred. The 2 patients were histologically proven to have nodal tumor recurrence and tuberculous lymphadenopathy, respectively. CONCLUSIONS Precise localization of a small lymph node located deep in the abdomen can be readily performed by intraoperative LUS.
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Affiliation(s)
- Honsoul Kim
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Korea
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Morris-Stiff G, Cheang P, Key S, Verghese A, Havard TJ. Does the surgeon still have a role to play in the diagnosis and management of lymphomas? World J Surg Oncol 2008; 6:13. [PMID: 18248683 PMCID: PMC2254406 DOI: 10.1186/1477-7819-6-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 02/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the course of the past 40 years, there have been a significant number of changes in the way in which lymphomatous disease is diagnosed and managed. With the advent of computed tomography, there is little role for staging laparotomy and the surgeon's role may now more diagnostic than therapeutic. AIMS To review all cases of lymphoma diagnosed at a single institution in order determine the current role of the surgeon in the diagnosis and management of lymphoma. PATIENTS AND METHODS Computerized pathology records were reviewed for a five-year period 1996 to 2000 to determine all cases of lymph node biopsy (incisional or excisional) in which tissue was obtained as part of a planned procedure. Cases of incidental lymphadenopathy were thus excluded. RESULTS A total of 297 biopsies were performed of which 62 (21%) yielded lymphomas. There were 22 females and 40 males with a median age of 58 years (range: 19-84 years). The lymphomas were classified as 80% non-Hodgkin's lymphoma, 18% Hodgkin's lymphoma and 2% post-transplant lymphoproliferative disorder. Diagnosis was established by general surgeons (n = 48), ENT surgeons (n = 9), radiologists (n = 4) and ophthalmic surgeons (n = 1). The distribution of excised lymph nodes was: cervical (n = 23), inguinal (n = 15), axillary (n = 11), intra-abdominal (n = 6), submandibular (n = 2), supraclavicular (n = 2), periorbital (n = 1), parotid (n = 1) and mediastinal (n = 1). Fine needle aspiration cytology had been performed prior to biopsy in only 32 (52%) cases and had suggested: lymphoma (n = 10), reactive changes (n = 13), normal (n = 5), inadequate (n = 4). The majority (78%) of cervical lymph nodes were subjected to FNAC prior to biopsy whilst this was performed in only 36% of non-cervical lymphadenopathy. CONCLUSION The study has shown that lymphoma is a relatively common cause of surgical lymphadenopathy. Given the limitations of FNAC, all suspicious lymph nodes should be biopsied following FNAC even if the FNAC is reported normal or demonstrating reactive changes only. With the more widespread application of molecular techniques, and the development of improved minimally-invasive procedures, percutaneous and endoscopic techniques may come to dominate, however, at present; the surgeon still has an important role to play in the diagnosis if not treatment of lymphomas.
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Affiliation(s)
- Gareth Morris-Stiff
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK.
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