Accuracy and Cost-Effectiveness of Core Needle Biopsy in the Evaluation of Suspected Lymphoma: A Study of 101 Cases

Abstract

Context.—Lymphomas have traditionally been diagnosed on excisional biopsies of lymph nodes in order to evaluate tissue architecture and cytomorphology. Recent lymphoma classification schemes emphasize immunophenotypic, genetic, and molecular aspects in addition to morphology as diagnostic features. Core needle biopsies are increasingly being used to obtain tissue for diagnosis in patients with lymphadenopathy and a clinical suspicion of lymphoma. These procedures are rapid, minimally invasive, well tolerated, and may provide some architectural framework (unlike fine-needle aspirations), as well as material for ancillary studies. Objective.—To explore the accuracy, utility, and cost-effectiveness of this technique. Design.—Core needle biopsies of 101 consecutive patients from 2 large community hospitals who were suspected of having primary or recurrent lymphomas were retrospectively reviewed. All patients had hematoxylin-eosin–stained sections of needle cores. Specimens morphologically suspicious for lymphoma were subjected to ancillary studies, including immunohistochemistry, flow cytometry, and/or molecular studies. Core needle biopsy diagnoses were correlated with subsequent excisional biopsies, if performed. Results.—Core needle biopsies established a definitive pathologic diagnosis for the vast majority of cases. A diagnosis was considered sufficient to begin treatment for primary and recurrent lymphomas in most cases. Compared with an open biopsy, there is a cost savings of greater than 75%. Conclusion.—The accuracy of this technique, along with the cost savings and decreased morbidity, suggest that this method may be used safely and reliably as a first-line diagnostic technique.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Evaluation of Suspected Lymphoma

“…Previous studies have emphasized that low-volume tissue samples may avoid the need for surgical diagnosis in lymphoma. [25][26][27] Our results suggest the use of EBUS-TBNA inpatients with undifferentiated lymphadenopathy when lymphoma is a suspected diagnosis is reasonable, despite the necessity to proceed to a surgical diagnosis in a proportion of patients. It is likely that EBUS-TBNA may avoid both the morbidity and the financial costs associated with more invasive surgical procedures although it should be undertaken with the patient's understanding that further morphologic characterization of their disease by invasive surgical biopsy may be required.…”

Synchronous early‑stage breast cancer and axillary follicular lymphoma diagnosed by core needle biopsy: A case report

“…The European Society for Medical Oncology has long considered surgical resection to be the gold standard biopsy method for staging ML due to the need for adequate tissue samples ( 36 ). However, in recent years, an increasing number of reports have shown that the diagnostic accuracy of subtype classification techniques using CNB is comparable to that of surgical resection ( 37 , 38 ), whereas CNB is superior to surgical resection in terms of the waiting period for examination, time required for the examination per se , invasiveness and medical costs ( 39 , 40 ). Both CNB and surgical biopsy of Ax LN specimens may be used to diagnose FL, with comparable results in terms of accuracy.…”

The value of sonographically guided fine-needle aspiration in the diagnosis of small lymph

“…Ultrasoundguided CNB can generally obtain a sufficient specimen and preserve the surrounding tissue structure, allowing immunohistochemistry analysis based on histomorphological examination, resulting in high diagnostic efficiency (6)(7)(8)(9). However, for lymph nodes with small short-axis diameters, the application of CNB is very limited and is associated with complications such as hemorrhage and nerve injuries (10,11). Cytological examination via ultrasound-guided FNA has the advantages of producing minimal trauma, simple and rapid execution (12), very good patient compliance and a low incidence of serious complications.…”