Laura Groneck1, Alexander Quaas2, Michael Hallek3,4, Thomas Zander3,4, Martin R Weihrauch5. 1. Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinik Köln, Köln, Germany. laura.groneck@uk-koeln.de. 2. Institut für Pathologie, Universitätsklinik Köln, Köln, Germany. 3. Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinik Köln, Köln, Germany. 4. Centrum für Integrierte Onkologie CIO Köln, Köln, Germany. 5. MVZ Onkologie, Universitätsklinik Köln, Köln, Germany.
Abstract
BACKGROUND: For the histopathological diagnosis of lymphoma, lymph node excision biopsies are regarded as standard of care. In contrast, for the diagnosis of carcinoma and deep-seated tumors, core needle biopsies (CNBs) are accepted as a sufficient sampling method. We evaluated a diagnostic algorithm for peripheral lymphadenopathy starting with ultrasound-guided CNB followed by excisional biopsy in ambiguous cases. METHODS: We performed ultrasound-guided CNB of peripheral lymph nodes and subcutaneous tumors in patients with lymphadenopathy in routine care and analyzed its accuracy, complication rate, and the impact of needle sizes on results. RESULTS: From 138 patients, 132 samples were technically adequate. In 121 patients, CNB provided a clinically actionable diagnosis (76 lymphoma, 30 carcinoma, 15 non-malignant diagnoses). A total of 54 patients had a secondary biopsy. Inconclusive diagnoses were rare with two false-positive and two false-negative non-Hodgkin's lymphoma, and higher for Hodgkin's lymphoma with five false-negative cases. The rate of complications was low. Needle size did not significantly influence results. CONCLUSION: Ultrasound-guided CNBs are a safe, quick, and valid tool for the workup of lymphadenopathy. Yet, a benign diagnosis from CNB must be completed by a secondary biopsy if clinical presentation suggests malignant disease.
BACKGROUND: For the histopathological diagnosis of lymphoma, lymph node excision biopsies are regarded as standard of care. In contrast, for the diagnosis of carcinoma and deep-seated tumors, core needle biopsies (CNBs) are accepted as a sufficient sampling method. We evaluated a diagnostic algorithm for peripheral lymphadenopathy starting with ultrasound-guided CNB followed by excisional biopsy in ambiguous cases. METHODS: We performed ultrasound-guided CNB of peripheral lymph nodes and subcutaneous tumors in patients with lymphadenopathy in routine care and analyzed its accuracy, complication rate, and the impact of needle sizes on results. RESULTS: From 138 patients, 132 samples were technically adequate. In 121 patients, CNB provided a clinically actionable diagnosis (76 lymphoma, 30 carcinoma, 15 non-malignant diagnoses). A total of 54 patients had a secondary biopsy. Inconclusive diagnoses were rare with two false-positive and two false-negative non-Hodgkin's lymphoma, and higher for Hodgkin's lymphoma with five false-negative cases. The rate of complications was low. Needle size did not significantly influence results. CONCLUSION: Ultrasound-guided CNBs are a safe, quick, and valid tool for the workup of lymphadenopathy. Yet, a benign diagnosis from CNB must be completed by a secondary biopsy if clinical presentation suggests malignant disease.
Authors: Alexander Chan; Jose Victor Scarpa Carniello; Qi Gao; Allison Sigler; Jeeyeon Baik; Mikhail Roshal; Oscar Lin Journal: Arch Pathol Lab Med Date: 2022-04-01 Impact factor: 5.686