Randomized comparison of power Doppler ultrasonography-guided core-needle biopsy with open surgical biopsy for the characterization of lymphadenopathies in patients with suspected lymphoma

Abstract

The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. We employed power Doppler ultrasonography (PDUS) to select the lymph node most suspected of malignancy and to histologically characterize it through the use of large cutting needle. Institutional review board approval and informed consent were obtained for this randomized clinical trial. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either standard surgery or PDUS-guided 16-gauge modified Menghini needle. The primary endpoint was the superiority of sensitivity for the diagnosis of malignancy for core-needle cutting biopsy (CNCB). Secondary endpoints were times to biopsy, complications, and costs. A total of 376 patients were randomized into the two arms and received allocated biopsy. However, four patients undergoing CNCB were excluded for inadequate samples; thus, 372 patients were analyzed. Sensitivity for the detection of malignancy was significantly better for PDUS-guided CNCB [98.8%; 95% confidence interval (CI), 95.9–99.9] than standard biopsy (88.7%; 95% CI, 82.9–93; P < 0.001). For all secondary endpoints, the comparison was significantly disadvantageous for conventional approach. In particular, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with CNCB. The presence of satellite enlarged reactive and/or necrotic lymph nodes may impair the success of an open surgical biopsy (OSB). PDUS and CNCB with adequate gauge are diagnostic tools that enable effective, safe, fast, and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention.

Value and Diagnostic Accuracy of Ultrasound‐Guided Full Core Needle Biopsy in the Diagnosis of Lymphadenopathy: A Retrospective Evaluation of 793 Cases

“…A smaller previous study compared 14‐gauge CNB with SNE and found discrepant diagnostic results in 9.1% of cases . In another study, CNB and SNE were prospectively compared, and superiority was seen for CNB . Thus, a comparison of the diagnostic accuracy of SNE versus CNB or FCNB is warranted.…”

“…This is an important issue regarding the generalizability of our results. For example, it is well established that interobserver variability and US experience have a major impact on results . In this study, all LN biopsies were performed by an examiner with greater than 35 years of US experience.…”

Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience

“…One main concern of FNAB/CNB is that findings may not be representative of the entire lesion, but the chances of missing a high-grade component can be reduced if clinical and radiological findings are correlated. A comparative study showed that power Doppler ultrasonography-guided CNB had better sensitivity for the detection of lymphoma in lymph nodes than open surgical biopsy [29]. This emphasizes the importance of imaging studies in the diagnosis of lymphoma.…”

Microfluidic chip technology applied to fine‐needle aspiration cytology samples for IGH clonality assessment

“…A histological diagnosis was available in 16 of 35 cases (45.7%): a core-needle cutting biopsy was performed in 12 cases under ultrasound guidance as previously described, 15 and an excisional biopsy in the remaining four cases. Clinical follow-up data were available for all patients.…”