Core Needle Biopsy Targeting the Viable Area of Deep-Sited Dominant Lesion Verified by Color Doppler and/or Contrast-Enhanced Ultrasound Contribute to the Actionable Diagnosis of the Patients Suspicious of Lymphoma

Abstract

Background: Inadequate accuracy of ultrasound-guided core needle biopsy (US-CNB) urges further improvement for the diagnosis and management of lymphoma to meet with the practitioners' increased reliance on this mini-invasive approach. Methods: Data related to US-CNB of the deep-sited dominant lesions suspicious of lymphoma detected by computer tomography or positron-emission tomography/computer tomography for eligibility assessment of three prospective clinical trials were collected in advance. A retrospective analysis of the prospective data collection was performed, in which Viable-targeting US-CNB that Color Doppler flow imaging (CDFI) and/or contrast enhanced ultrasound (CEUS) were employed to select viable area for biopsy target compared with Routine US-CNB that routine procedure of evaluation and guidance using gray-scale ultrasound with CDFI in terms of the yield of clinically actionable diagnosis and safety, and determinants for the successful US-CNB that established an actionable diagnosis were explored. The establishment of final diagnosis was based on surgical pathology or medical response to therapy with follow-up at least 6 months. Results: A total of 245 patients underwent Routine US-CNB (N = 120) or Viabletargeting US-CNB (N = 125), of which 91 (91/120, 75.8%) and 112 (112/125, 89.6%) were revealed with actionable diagnoses, respectively (p = 0.004, OR 0.846, 95%

Lymph Node Ultrasound in Lymphoproliferative Disorders: Where Are We Now?

“…[ 4 - 6 ] Furthermore, it seems that power Doppler and CEUS techniques can further improve the accuracy of the procedure, thanks to their ability to examine intranodal vessels. [ 5 , 7 ]…”

“…On the other hand, lymphomas spread from the center of the node to the periphery and develop hyperplastic vessels, leading to the characteristic homogeneous centrifugal enhancement with no perfusion defects. [ 11 , 19 ] Then, during the diagnostic workup, vasculature studies can provide indications on which LN to sample [ 5 , 7 ] and can be useful in staging and predicting outcome. [ 8 ] It has been found that angiogenesis is more prominent in more aggressive lymphoma subtypes and seems to correlate with more aggressive disease and poorer outcome.…”

“…In addition, blood flow, transverse axis of the lesion, and mean PET standardized uptake value represented predictor of successful diagnosis. [ 7 ]…”

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

“…We also explored the time from the first visit to biopsy and diagnosis. The endpoint of the biopsy pro-cedure was whether the clinicians can determine the treatment strategy based on the pathological results, the so-called actionable diagnosis [12]. The present study was approved by the Ethics Committee of the National Cancer Center (Approval number: 2017-161).…”

Critical Role of Flow Cytometric Immunophenotyping in the Diagnosis, Subtyping, and Staging of T-Cell/NK-Cell Non-Hodgkin’s Lymphoma in Real-World Practice: A Study of 232 Cases From a Tertiary Cancer Center in India

“…In such a scenario, the diagnosis solely depends on the core-needle biopsies (CNBs) and radiological findings (25,26). Several reports have highlighted the limitations of CNB-based diagnosis of NHL due to inadequate tissue as being responsible for the inability to evaluate histopathological patterns and immunophenotype by IHC (27)(28)(29)(30)(31)(32). Thus, lower incidence, inadequate immunophenotyping workup, limited tissue, and lack of expertise collectively contribute to inadequate opinion, incorrect subtyping, or sometimes even misdiagnosis such as Hodgkin's lymphoma, Bcell NHL (B-NHL), inflammatory process, or reactive proliferation in a significant percentage of T-NHL, skewing the true incidence (12,14,25,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51).…”