Lymph node core biopsies reliably permit diagnosis of lymphoproliferative diseases. Real‐World Experience from 554 sequential core biopsies from a single centre

Abstract

Introduction Whilst excision biopsy is traditionally preferred, advances in radiological and histological techniques warrant a re‐look at core biopsy as a viable primary diagnostic method. Method Over a 3‐year period, all patients who underwent core biopsy to investigate lymphoma at our centre were included. Results 554 consecutive patients were included (40.1% prior lymphoma and 59.4% new presentations). Three or more cores were taken in 420 (75.8%) cases. Median time from request to biopsy and biopsy to histology report was 2 (0‐40) days and 7 (1‐24) days, respectively. 510/544 (93.8%) biopsies were diagnostic. There was no difference in whether the biopsy was diagnostic based on indication (new vs. relapsed lymphoma) (P = .445), whether biopsy was PET‐directed (P = .507), for T‐cell lymphoma (P = .468) or nodal vs. extra‐nodal (P = .693). Thirty‐eight patients (6.9%) required a second biopsy due to inadequate tissue. In a patient experience survey, only 13.9% reported any complications (1 self‐limiting minor bleeding, 4 bruising) whilst 16.7% reported any discomfort beyond 12 hours. Conclusion Core biopsy performed by experienced radiologists and analysed by expert haemato‐pathologists is a reliable, well‐tolerated method for diagnosing lymphoma and confirming relapse. Multiple cores can be obtained under local anaesthetic yielding sufficient material in the majority of cases.

Lymph node core needle biopsy for the diagnosis of lymphoproliferative disorders: A word of caution

“…We read with interest the study by Cohen and colleagues addressing the role of lymph node core biopsy (LNCB) for the diagnosis of lymphoproliferative disorders (LPDs). 1 Although we agree that LNCB provides diagnostic clues in most instances, we think that it should not be adopted routinely. We believe, instead, that incisional/excisional biopsies should be performed in all suitable cases.…”

“…The latter should indeed consider also measures of outcomes that are likely affected by the lower diagnostic accuracy of LNCB. 6 Many studies indicate the safety of LNCB as an advantage over incisional/excisional sampling 1,5,7,8 : our experience and literature data nonetheless suggest low complication rates also for surgical biopsies. 9 Lastly, the widespread application of LNCBs raises epistemological issues.…”

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

“…Among the 96 patients with nodal lesions diagnosed as lymphomatous on the reference standard, 90 were classified in the same way, that is, as HL, by reference standard as they were by CNB; consequently, the accuracy rate of lymph node status was 94% (95% CI 87–97%) for PDUS‐guided 16‐G CNB (Table II). 6,11,15 Noteworthy, in our hands, the rate of failure with core biopsy was very low. In fact, stiffened tissue of the nodal sclerosis HL, which was seated in the sub‐clavicular area (a particulary difficult region) led to a sampling error of CNB in only a minority of patients, that is, six patients with fibrotic samples, that necessarily required re‐biopsy (surgical resection) for correctly diagnosing the disease.…”

“…However, haematology institutions of international prestige from different countries rely on imaging-guided CNB to determine lymphomas diagnosis in real-life and/or in clinical trials. [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.…”

“…Importantly, they limited the use of ultrasound‐guided CNB of lymph nodes contingent to a few instances, that is, when surgical intervention is impractical or would entail excessive risk. However, haematology institutions of international prestige from different countries rely on imaging‐guided CNB to determine lymphomas diagnosis in real‐life and/or in clinical trials 8–11 …”