Image‐guided core needle biopsy as the first‐line diagnostic approach in lymphoproliferative disorders—A review of the current literature

Abstract

The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost‐effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%‐93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well‐tolerated and should be considered the first‐line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.

Use of Core-Needle Biopsy for the Diagnosis of Malignant Lymphomas in Clinical Practice

“…In recent decades, CNB has virtually become one of the initial diagnostic methods for lymphoma in many centers [10]. Additionally, the recently published literature review article confirmed the usefulness of CNB because of its diagnostic efficacy, reproducibility, and safety [11]. In this review, CNB demonstrated a high diagnostic rate (79–97%), high reproducibility among pathologists (87–93%), and minimal invasiveness.…”

Correspondence in reference to the previously published Epub manuscript by Peter Hokland et al. ‘How I treat advanced Hodgkin lymphoma – a global view’. Br J Haematol. 2020;190:837–50

“…[8][9][10][11] Several attempts have been made in this patient setting to define the best first-line interventional diagnostic strategy to obtain pathological lymph node tissue. 12 There is the need to achieve accuracy of the diagnostic evaluation, while reducing adverse events, costs and waiting time for the performance of a biopsy, that is, the need for a true cost-effective interventional procedure. We reported in Annals of Hematology in 2017 13 encouraging single-centre efficacy and safety results of a prospective trial in which 376 patients with lymph node enlargement suspected of lymphoma were randomly assigned to biopsy with either standard surgery [open surgical biopsy (OSB)] or power Doppler ultrasonography (PDUS)-guided 16-G modified Menghini CNB.…”

“…Several attempts have been made in this patient setting to define the best first‐line interventional diagnostic strategy to obtain pathological lymph node tissue 12 . There is the need to achieve accuracy of the diagnostic evaluation, while reducing adverse events, costs and waiting time for the performance of a biopsy, that is, the need for a true cost‐effective interventional procedure.…”

Variant histology in nodular lymphocyte predominant Hodgkin lymphoma in an adult population: disease investigations and characteristics from a retrospective cohort

“…Accurate diagnosis with full histological subclassification relies on obtaining an adequate tissue sample. WHO and other expert-developed guidelines for lymphoma diagnosis recommend whole node surgical excision biopsy (SEB) as the preferred diagnostic investigation for suspected lymphoma 9–12. However, recent improvements to radiological and histopathological techniques may make core needle biopsy (CNB) more acceptable than previously thought.…”

“…However, recent improvements to radiological and histopathological techniques may make core needle biopsy (CNB) more acceptable than previously thought. One recent review reports a median diagnostic yield with full lymphoma subtyping of 92% for CNB cases, while 97.5% of SEBs were fully diagnostic 9. Another recent study found that 7% of patients required a second biopsy due to inadequate tissue after undergoing CNB 13.…”