Formulating a Treatment Plan in Suspected Lymphoma: Ultrasound‐Guided Core Needle Biopsy Versus Core Needle Biopsy and Fine‐Needle Aspiration of Peripheral Lymph Nodes

Drylewicz, Monica R.; Watkins, Marcus; Shetty, Anup S.; Lin, Michael; Salter, Amber; Bartlett, Nancy L.; Middleton, William D.; Yano, Motoyo

doi:10.1002/jum.14724

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…All biopsy samples with suspicious lymphoid infiltrates were reviewed by hematopathologists, and a final diagnosis was achieved through integration of histopathology, immunohistochemistry, and flow cytometry and/or molecular studies. The utility of CNB was judged by whether it yielded an actionable diagnosis, allowing for either initiation of treatment or final determination of benignity requiring no further intervention (6).…”

Section: Methodsmentioning

confidence: 99%

Ultrasound‐Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren’s Syndrome

Baer

Grader‐Beck

Antiochos

et al. 2021

Arthritis Care & Research

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Objective To evaluate the safety and utility of core needle biopsy (CNB) for diagnosis of salivary gland lymphoma in Sjögren’s syndrome (SS). Methods We analyzed data from consecutive SS patients who underwent ultrasound‐guided major salivary gland CNB for lymphoma diagnosis and determined whether CNB yielded an actionable diagnosis without need for further intervention. Results CNBs were performed in 24 patients to evaluate discrete parotid (n = 6) or submandibular (n = 2) gland masses or diffuse enlargement (n = 16; 15 parotid). One patient had 3 CNBs of the same mass. Of the 26 CNBs, 24 included flow cytometry, using CNB and/or fine needle aspirate material, and 14 targeted sonographically identified focal lesions. No patient reported complications. In the 23 patients with 1 CNB, final diagnoses were marginal zone lymphoma of mucosa‐associated lymphoid tissue (MALT; n = 6), atypical lymphoid infiltration (n = 3), benign lymphoepithelial sialadenitis (n = 9), normal gland tissue (n = 4), and lymphoepithelial cyst (n = 1). In the patient with serial CNBs, the initial one without flow cytometry was benign, but the next 2 showed atypical lymphoid infiltration. Monoclonal lymphoid infiltration was detected in 12 patients: 6 with MALT lymphoma, 3 were benign, and 3 with atypical lymphoid infiltration. Of the latter 3, 1 was treated with rituximab and 2 with expectant observation. The diagnosis changed from atypical lymphoid infiltration to MALT lymphoma in 1 patient following biopsy of inguinal adenopathy 6 months post‐CNB. CNB provided actionable results and avoided open excisional biopsies in all cases. Conclusion CNB is safe and useful in the evaluation of suspected salivary gland lymphoma in SS.

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Section: Methodsmentioning

confidence: 99%

Ultrasound‐Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren’s Syndrome

Baer

Grader‐Beck

Antiochos

et al. 2021

Arthritis Care & Research

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“…17 A spring-loaded side notch or hollow-bore needle to obtain a solid core of tissue from the target lesion is F I G U R E 4 A-E, Forest plot on accuracy of CNB for lymphoma diagnosis-divided by lymphoma subtypes applied. 28 For best diagnostic results, the operator should perform several passes with a large bore needle and avoid necrotic areas. 8,29 The diagnostic yield is also affected by the operator's expertise and experience.…”

Section: Discussionmentioning

confidence: 99%

“…CNB has now become popular as a diagnostic tool for suspected lymphoma presenting in the head and neck 17 . A spring‐loaded side notch or hollow‐bore needle to obtain a solid core of tissue from the target lesion is applied 28 . For best diagnostic results, the operator should perform several passes with a large bore needle and avoid necrotic areas 8,29 .…”

Section: Discussionmentioning

confidence: 99%

Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta‐analysis

et al. 2020

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Background The diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma. Methods We conducted a meta‐analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB. Patients with a diagnosis other than lymphoma were excluded. All cases diagnosed with lymphoma sufficient to guide treatment based on CNB outcome were considered accurate (actionable) results. A separate meta‐analysis was performed for various lymphoma subtypes. Results Three prospective and 19 retrospective studies, comprising 1120 patients, met the inclusion criteria. The rate of actionable lymphoma diagnoses following CNB ranged from 30% to 96.3%, with a random‐effects model of 82.45% (95% confidence interval [CI] =0.76‐0.88) and a fixed‐effects model of 78.3% (95% CI =0.75‐0.80). Conclusion CNB for cervical lymphadenopathy in lymphoma cases is relatively accurate in guiding treatment.

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“…Recently, an international committee of cytopathologists proposed guidelines for standardizing the evaluation of lymph nodes by FNA cytopathology [1]. Prior studies have shown that FNA in conjunction with CNB help categorize lymph node specimens with actionable diagnoses in 67–100% of cases, allowing initiation of treatment or a definitive determination of benign etiology that requires no further intervention [2, 3]. While FNA is a helpful tool to rule-in or rule-out lymphoma, these studies have noted that FNA still shows limitations in accurate subclassification of lymphomas.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Considerations in the Evaluation of Large B-Cells on Lymph Node Cytology Specimens

et al. 2020

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Fine needle aspiration (FNA) has become increasingly popular in the evaluation of lymph nodes for lymphoproliferative disorders, but there are limitations to accurate subclassification of lymphoma using morphology alone. This case aims to expand diagnostic considerations of large B-cell populations identified on FNA material. We also address the significance of Epstein-Barr virus (EBV) DNA in the workup of patients with suspected lymphoma by FNA.

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Formulating a Treatment Plan in Suspected Lymphoma: Ultrasound‐Guided Core Needle Biopsy Versus Core Needle Biopsy and Fine‐Needle Aspiration of Peripheral Lymph Nodes

Abstract: In cases of suspected lymphoma, CNB without FNA was sufficient to obtain an actionable diagnosis.

Cited by 14 publications

References 21 publications

Ultrasound‐Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren’s Syndrome

Ultrasound‐Guided Biopsy of Suspected Salivary Gland Lymphoma in Sjögren’s Syndrome

Core needle biopsy for diagnosing lymphoma in cervical lymphadenopathy: Meta‐analysis

Diagnostic Considerations in the Evaluation of Large B-Cells on Lymph Node Cytology Specimens

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