Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas

Abstract

It is commonly admitted that the diagnosis of lymphomas can be assessed by the image-guided needle biopsy (IGNB) of deep lymph nodes. However, when peripheral lymph nodes are present, surgical dissection remains the standard strategy. The aim of this study was to evaluate the diagnostic yield of IGNB of peripheral lymph nodes in patients with suspected lymphomas. The records of 180 multisampling IGNBs of peripheral lymph nodes in 180 patients were reviewed. One hundred and twenty-three IGNBs were observed at first diagnosis and 57 at progression using large-cutting core-biopsy needles ranging between 18 G and 14 G in size. Immunohistochemistry studies were performed in all cases and at least one biopsy was systematically frozen. A diagnosis of lymphoma with sufficient information such that a therapeutic decision could be made was obtained in 146 of the 152 patients with lymphoproliferative disorders (96%). IGNB was equally effective in making the correct diagnosis of lymphoma at the time of original diagnosis than at relapse. The results did not depend on the biopsy site, lymph nodes size, or needle type. We recommend that IGNB may be performed as an initial procedure for the diagnosis of lymphomas either in the presence of peripheral or deep lymph nodes, as it avoids surgery.

Diagnostic precision of image-guided multisampling core needle biopsy of suspected lymphomas in a primary care hospital

“…It is important to note that the lack of precise subtyping/grading in a minority of cases did not preclude a therapeutic decision to be made for 62/63 patients (98%) with lymphoma. These rates not only compare favourably with those obtained in more homogeneous patient populations (de Kerviler et al, 2000(de Kerviler et al, , 2007Demharter et al, 2001;Screaton et al, 2002;Balestreri et al, 2005;Li et al, 2005;Sklair-Levy et al, 2005;de Larrinoa et al, 2007;Lachar et al, 2007) but also with results usually obtained by complete lymph node analysis. On the other hand, the diagnostic yield of CNB for diagnosis of benignity was only 53%, confirming that a definitive diagnosis for a benign disorder is a difficult task.…”

“…Thus, image-guided Diagnostic precision of multisampling CNB P Loubeyre et al large-cutting CNB has been proposed as the initial procedure for the diagnosis of deep-seated lymphomas (de Kerviler et al, 2000;Demharter et al, 2001;Balestreri et al, 2005;Li et al, 2005;SklairLevy et al, 2005;Lachar et al, 2007;de Larrinoa et al, 2007), and in some institutions for suspect peripheral lymph nodes (Screaton et al, 2002;de Kerviler et al, 2007). Although variable endpoints were analysed in those studies with highly diverse designs, CNB appears to be a valuable approach with sensitivity for diagnosing lymphoma at 87 -89% (Demharter et al, 2001;Balestreri et al, 2005), overall diagnostic yield at 84% , unequivocal diagnosis of lymphoma at 91% (Lachar et al, 2007), overall diagnostic accuracy for lymphoma typing at 88% (de Larrinoa et al, 2007), sufficient information such that a therapeutic decision could be made at 96% (de Kerviler et al, 2007) and diagnosis of lymphoma with subtyping ranging from 76 to 85% (de Kerviler et al, 2000;Li et al, 2005). However, the validity of CNB for lymphoma diagnosis is still controversial, and entire lymph node removal is often proposed as the best procedure Engert and Dreyling, 2008;Tilly and Dreyling, 2008).…”

“…However, the validity of CNB for lymphoma diagnosis is still controversial, and entire lymph node removal is often proposed as the best procedure Engert and Dreyling, 2008;Tilly and Dreyling, 2008). Moreover, most of the studies (de Kerviler et al, 2000;Demharter et al, 2001;Screaton et al, 2002;Balestreri et al, 2005;Li et al, 2005;Sklair-Levy et al, 2005;de Kerviler et al, 2007;de Larrinoa et al, 2007;Lachar et al, 2007) include patients with a high probability of lymphoma diagnosis assessed in reference centres for lymphoproliferative diseases. This study was designed to determine whether CNB can also be recommended in the context of a primary care hospital where a large range of malignant and benign diagnoses can be expected.…”

“…In an attempt to optimise the accuracy of CNB in this challenging setting, a large number of samples were collected, whereas the mean number of samples harvested in the previous studies varied from 1 to 4.5. Moreover, although this was apparently achieved in one previous series only (de Kerviler et al, 2007), fresh tissue was used for flow cytometry analysis and two cores of tissue were systematically frozen, allowing for further morphological, immunochemistry and molecular studies. Those additional samples were useful to establish a precise diagnosis in 40% of cases (data not shown).…”

“…However, the excisional biopsy of enlarged lymph nodes is still advocated as the gold standard in the diagnostic evaluation of lymphoma Engert and Dreyling, 2008;Tilly and Dreyling, 2008). Nonetheless, in several centres, percutaneous image-guided CNB, which is a minimally invasive procedure, is used as an alternative to excisional biopsy for diagnosing lymphomas (de Kerviler et al, 2000;Demharter et al, 2001;Screaton et al, 2002;Balestreri et al, 2005;Li et al, 2005;Sklair-Levy et al, 2005;Lachar et al, 2007;de Kerviler et al, 2007;de Larrinoa et al, 2007). This is particularly true if suspected nodes or masses are deep seated or if the clinical condition of patients is severely impaired.…”