Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation

Mou, Eric; Falchi, Lorenzo; Sundaram, Vandana; Abramson, Jeremy S.; Balassanian, Ronald; Beygi, Sara; Fitzpatrick, Megan J.; Frank, Annabel K; Gupta, Srishti; Lin, Oscar; Long, Steven; Menke, Joshua; Reed, Daniel; Ruíz-Cordero, Roberto; Volaric, Ashley; Xie, Youhua; Wang, Linlin; Wen, Kwun Wah; Zadeh, Sara L.; Natkunam, Yasodha; Cheung, Matthew C.; Gratzinger, Dita

doi:10.1080/10428194.2021.1941936

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…These findings highlight the clinical value of FNA as a screening tool to identify patients in need of more comprehensive lymphoma evaluation. A recent study from our consortium also found that time to diagnosis among FL patients with clinical suspicion for transformation was similar regardless of whether a diagnostic workup began with FNA, NCB, or surgical biopsy, 27 suggesting that beginning with either FNA or NCB will likely not result in delays in diagnosis or treatment, and decisions regarding biopsy type should be tailored to meet patient needs. The choice of biopsy type depends on numerous factors including patient comorbidities and preferences, resource availability, and the degree of clinical suspicion for lymphoma.…”

Section: Discussionmentioning

confidence: 80%

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

Fitzpatrick

Sundaram

et al. 2022

Cancer Cytopathology

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Background: Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL). Methods:The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Section: Discussionmentioning

confidence: 80%

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

Fitzpatrick

Sundaram

et al. 2022

Cancer Cytopathology

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“…A recent study by the authors' consortium evaluated time to final diagnosis in the setting of a history of FL with suspected transformation and determined that initial biopsy type, whether FNA, NCB, or surgical excision, did not significantly impact time to final diagnosis. 15 This reflects the utility of SVB as a screening diagnostic modality in evaluating FL.…”

Section: Discussionmentioning

confidence: 91%

“…In addition, the need for more tissue, as reflected in the increased surgical excisions upon final biopsy, is compatible with the diagnostic limitation of SVB to provide a definite classification and/or grading. A recent study by the authors’ consortium evaluated time to final diagnosis in the setting of a history of FL with suspected transformation and determined that initial biopsy type, whether FNA, NCB, or surgical excision, did not significantly impact time to final diagnosis 15. This reflects the utility of SVB as a screening diagnostic modality in evaluating FL.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma

Volaric

Lin²,

Balassanian³

et al. 2022

American Journal of Surgical Pathology

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Small-volume biopsies (SVBs) including fine-needle aspiration (FNA), cell block, and needle core biopsies (NCB) are increasingly utilized to diagnose and guide the clinical management of lymphoma. We established a multi-institutional interdisciplinary collaboration of cytopathologists, hematopathologists, and oncologists focused on the role of SVB in the management of patients with follicular lymphoma (FL). To assess the performance characteristics of SVB in this setting, we evaluated all consecutive SVBs performed for clinical indications of initial diagnosis, recurrence, or transformation of FL over a 5-year period and focused on the 182 that had at least one subsequent biopsy within 3 months as part of the same clinical work-up. The most common outcome of a subsequent biopsy as part of the same clinical work-up was a more specific diagnosis usually assigning the pathologic grade (111/182, 61%), followed by a complete agreement with the SVB (24/182, 13%), and change from nondiagnostic on initial biopsy to diagnostic on subsequent biopsy (21/182, 12%). A minority resulted in a diagnostic change from benign to lymphoma (17/182, 9%), a change in FL grade (5/182, 3%), or change in the lymphoma diagnostic category (4/182, 2%). There were no cases where an initial diagnosis of lymphoma was overturned. The distribution of discrepancies was similar across initial SVB types (FNA, FNA + cell block, NCB with or without FNA). Tissue limitations were noted in a minority of cases (53/182, 29%) and were enriched among initially nondiagnostic biopsies (16/21, 76%). Flow cytometry immunophenotyping was performed in the majority of cases both at the first and last biopsy (147/182, 81%). SVB can be a powerful method to detect FL in various clinical indications, with discrepant cases mostly resulting from a refinement in the initial diagnosis.

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“…Despite these limitations, a recent large multi‐institutional study evaluating median time from clinical suspicion of FL transformation to final diagnostic biopsy, found no significant difference in time to final diagnosis regardless of initial biopsy type (FNA, CNB or SB) despite a higher number of subsequent biopsies if FNA was the initial diagnostic procedure 53 . This study suggests that although final classification and grading of FL can be challenging on small biopsies and may not lead to an actionable diagnosis, beginning with FNA does not appear to delay time to final diagnosis and therefore, FNA can be a reasonable first step.…”

Section: Core Needle Biopsy Diagnostic Performancementioning

confidence: 99%

Uses and limitations of small‐volume biopsies for the diagnosis of lymphoma

Fitzpatrick,

Sohani,

2024

Cytopathology

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Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small‐volume biopsies including fine‐needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small‐volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.

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Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation

Cited by 4 publications

References 13 publications

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma

Uses and limitations of small‐volume biopsies for the diagnosis of lymphoma

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