Core Needle Biopsy in Lymphoma Diagnosis

Abstract

To compare the diagnostic accuracy of core needle biopsies (CNBs) and surgical excisional biopsies (SEBs), samples of lymphoid proliferation from a single institution from 2013 to 2017 (N=476) were divided into groups of CNB (N=218) and SEB (N=258). The diagnostic accuracy of these samples was evaluated as a percentage of conclusive diagnosis, according to the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. The contribution of clinical data, the assessment of sample adequacy by a pathologist during the procedure, the number and size of fragments, the needle gauge, the ancillary tests, and the type of lymphoid proliferation were also examined. The diagnostic accuracy of SEB was 97.3% and CNB 91.3% (P=0.010). Additional factors considered essential for establishing the final diagnosis in some cases were: clinical information (20.6% CNB, 7.4% SEB; P<0.001); immunohistochemistry (96.3% CNB, 91.5% SEB; P=0.024); flow cytometry (12% CNB, 6.8% SEB; P=0.165); and other complementary tests (8.2% CNB, 17.3% SEB; P=0.058). Factors that did not influence performance were the evaluation of sample adequacy during the procedure, the number and size of fragments, and the needle gauge. Increased percentage of nondiagnostic CNB was observed in T-cell lymphomas (30%), followed by classic Hodgkin lymphoma (10.6%). The main limitation of CNB was the evaluation of morphologically heterogenous diseases. CNB is useful and safe in lymphoma diagnosis provided it is carried out by a team of experienced professionals. Having an interventional radiology team engaged with pathology is an essential component to achieve adequate rates of specific diagnoses in CNB specimens.

The Etiologic Landscape of Lymphoproliferation in Childhood: Proposal for a Diagnostic Approach Exploring from Infections to Inborn Errors of Immunity and Metabolic Diseases

“…26 Excisional biopsy represents the gold standard for the diagnosis of lymphomas and has a greater sensibility and specificity compared with core needle biopsy and fine needle aspiration cytology (FNAC). [27][28][29][30] Lymph nodal excision, with a diagnostic and Notes: This algorithm identifies the patients with a clinical picture suggestive for infection (green boxes) and malignancy (red boxes) and those with a less defined clinical picture (yellow boxes). The diagnostic approach for patients with suspected infection or malignancy is provided, evidencing that first-level analysis and US imaging are mandatory in patients with high risk of malignancy.…”

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

“…8 Diagnostic yield of CNB with or without FNA has typically shown a high sensitivity and specificity of >90% among benign and malignant conditions 34,35 and also demonstrates a relatively high ability to subclassify lymphoma with a definitive diagnosis rate ranging from 79% to 97%. 7,9,[36][37][38][39][40][41][42][43][44][45] A recent large Italian study evaluating 1000 lymph node CNBs also found high interobserver correlation (median kappa score = 0.916) among independent evaluation by three pathologists in addition to high CNB sensitivity for malignancy. 42 A summary of major studies evaluating the diagnostic performance of CNB for the diagnosis of lymphoma performed within the last 5 years is provided in Table 1.…”

“…Among two recent large retrospective studies comparing CNB to SB, high definitive diagnosis rates on CNB were confirmed at 92.3% and 91.3%; however, SB demonstrated significantly higher definitive diagnosis rates of 98.1% and 97.3%, respectively. 37,47 Additionally, Syrykh et al found significantly more cases of unclassified lymphomas or equivocal diagnoses on CNB compared to SB (4.6% compared to 1.3%). 47 Interestingly, one prospective Italian study which randomized patients with lymphadenopathy suspicious for lymphoma into either a standard group undergoing SB (n = 187) or a CNB group (n = 185) with power Doppler ultrasonography found a higher sensitivity among the CNB group relative to the SB group (98.8% vs. 88.7%), a lower false-negative rate (1.1% vs. 10.2%), fewer procedurerelated complications and lower costs.…”

Follicular helper T-cell lymphomas: disease spectrum, relationship with clonal hematopoiesis, and mimics. A report of the 2022 EA4HP/SH lymphoma workshop

“…Except for one tonsillectomy, all submitted biopsies were from lymph nodes (LN). These comprised 19 surgical excisions and 5 core biopsies, reflecting increasing reliance on fast and minimally invasive small-volume biopsies for lymphoma diagnoses [ 19 – 21 ]. The submitted core biopsies were sufficient for diagnostic testing in all cases, including high-throughput sequencing (HTS) analyses performed in three cases.…”