Is lymph node core‐needle biopsy an alternative to excisional biopsy for the accurate staging of mycosis fungoides/Sézary syndrome and predicting the survival of patients?

2021 ◽  
Author(s):  
E. Hodak
Keyword(s):  
Lymph Node ◽  
Mycosis Fungoides ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Excisional Biopsy ◽  
Sézary Syndrome ◽  
Sezary Syndrome ◽  
Core Needle ◽  
Accurate Staging

Image guided lymph node core needle biopsy predicts survival in mycosis fungoides and Sézary syndrome

2021 ◽  
Author(s):  
J. Calvani ◽  
A. de Masson ◽  
C. de Margerie‐Mellon ◽  
É. de Kerviler ◽  
C. Ram‐Wolff ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mycosis Fungoides ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Sézary Syndrome ◽  
Sezary Syndrome ◽  
Core Needle ◽  
Image Guided

Image-guided lymph node core-needle biopsy predicts survival in mycosis fungoides and Sézary syndrome

2021 ◽  
Vol 156 ◽  
pp. S26
Author(s):  
Julien Calvani ◽  
Adèle De Masson ◽  
Constance De Margerie-Mellon ◽  
Eric De Kerviler ◽  
Caroline Ram-Wolff ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mycosis Fungoides ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Sézary Syndrome ◽  
Sezary Syndrome ◽  
Core Needle ◽  
Image Guided

scholarly journals Assessment of the Diagnostic Accuracy of Core Needle Biopsies in the Diagnosis of Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-13
Author(s):  
Xiangyun Ye ◽  
Catherine Tucker ◽  
Christopher Gardner ◽  
Austin Redilla ◽  
Guldeep Uppal ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Lymph Node ◽  
Core Needle Biopsy ◽  
Odds Ratio ◽  
Needle Biopsy ◽  
Excisional Biopsy ◽  
Diagnostic Odds Ratio ◽  
Chi Square ◽  
Core Needle ◽  
Adequate Tissue

Background: Excisional biopsy of the involved lymph node or tissue is the gold standard for diagnosing lymphoma. However, excisional biopsies are not always feasible depending on the location of the tumor. Recent literature suggests that novel diagnostic techniques such as immunohistochemistry, flow cytometry, FISH/Cytogenetics enhance the accuracy of less-invasive diagnostic procedures like Core needle biopsy (CNB) such that they are comparable to that of excisional biopsies. However, these studies were small and need further confirmation. Despite this, at our institution, CNB has been ordered with increasing frequency even for lymph nodes that can be surgically excised with ease (from 2016-2018 CNB for diagnosis of lymphoma increased from 19% to 31.6% of all lymph node biopsies for suspected lymphoma, with a slight decrease to 27.7% in 2019). Herein we review the diagnostic odds ratio and adequacy of a large dataset of patients who underwent either excisional or CNB at our institution. Methods: We performed a retrospective cohort study based on the results of lymph node biopsies collected from patients between January 1, 2016, and December 31, 2019, at Thomas Jefferson University Hospital. Biopsies performed externally and referred to our institution for analysis were excluded. The diagnostic odds ratio and confidence intervals were calculated using the Baptista-Pike method. The specimens were considered diagnostically inadequate if: 1. There was not enough lesional tissue for diagnosis or 2. Lesional tissue was present but the disease process was unable to be fully characterized. Adequacy of the specimens were then compared for statistical significance using a chi-squared test. Additional data collected included details of the biopsy procedure including whether a fine needle aspirate was collected, and pathologic workup such as ancillary studies (i.e. flow cytometry, cytogenetics, fluorescence in situ hybridization (FISH)), and reviewing pathologist. Results: A total of 579 biopsies were collected for review, 122 of which were excluded due to failure to meet our inclusion criteria. Thus, 457 biopsy samples were included in the final analysis, consisting of 339 excisional biopsy samples and 118 CNB samples. Excisional biopsies had adequate tissue to make a diagnosis 96.8% (328) of the time, while CNB's had adequate tissue to make a diagnosis 56.8% (67) of the time. The diagnostic odds ratio of CNB was determined to be 0.03583, [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p <0.0001 (Chi square). The 3 most common sites for a CNB were axillary (34.7%), Inguinal (14.4%), and supraclavicular (11.9%). For more details regarding lymphoma subtype, biopsy location, and reviewing pathologist see table 1. Inadequate core needle biopsy samples occurred regardless of needle size (12 gauge 0/4, 14 gauge 4/22, 16 gauge 0/2, 18 gauge 27/56, 20 gauge 5/13, 22 gauge 1/1, 25 gauge 0/1) and did not show statistically significant correlation (p = 0.0591, Chi square). Nineteen CNB's did not have needle gauge size available for analysis. Conclusions: Despite a recent trend moving away from excisional biopsies at our institution, our results indicate that excisional biopsy of lymph nodes in patients with suspected lymphoma should remain the standard of care. Interestingly the 3 most common sites in which a CNB was performed are easily accessible for excisional lymph node biopsy. Further research is needed to understand the reason for the trend away from excisional biopsy at our institution. Based on this preliminary research a quality improvement initiative is being implemented to reduce the number of core needle biopsies for suspected lymphoma, particularly for sites in which the lymph node can be easily excised. Disclosures Binder: Sanofi: Consultancy; Janssen: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Necessity of sentinel lymph node biopsy in ductal carcinoma in situ patients: a retrospective analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Young Duck Shin ◽  
Hyung-Min Lee ◽  
Young Jin Choi
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Ductal Carcinoma ◽  
Invasive Cancer ◽  
Total Mastectomy ◽  
Core Needle ◽  
Node Metastasis

Abstract Background Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. Methods We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Results The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Conclusions In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.

Diagnosing Lymphoproliferative Disorders Using Core Needle Biopsy Versus Surgical Excisional Biopsy: Three-Year Experience of a Reference Center in Lebanon

2020 ◽  
Vol 20 (8) ◽  
pp. e455-e460
Author(s):  
Nada Assaf ◽  
Samer Nassif ◽  
Hani Tamim ◽  
Ali Bazarbachi ◽  
Ghazi Zaatari ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Excisional Biopsy ◽  
Lymphoproliferative Disorders ◽  
Core Needle ◽  
Reference Center

Lobular In-Situ Neoplasia on Breast Core Needle Biopsy: Imaging Indication and Pathologic Extent Can Identify Which Patients Require Excisional Biopsy

2011 ◽  
Vol 19 (3) ◽  
pp. 914-921 ◽  
Author(s):  
Mara H. Rendi ◽  
Suzanne M. Dintzis ◽  
Constance D. Lehman ◽  
Kristine E. Calhoun ◽  
Kimberly H. Allison
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Excisional Biopsy ◽  
Core Needle

Role of image-guided core-needle biopsy in the management of patients with lymphoma.

1996 ◽  
Vol 14 (9) ◽  
pp. 2427-2430 ◽  
Author(s):  
V I Pappa ◽  
H K Hussain ◽  
R H Reznek ◽  
J Whelan ◽  
A J Norton ◽  
...  
Keyword(s):  
Core Needle Biopsy ◽  
Needle Biopsy ◽  
Previous History ◽  
Excisional Biopsy ◽  
Low Grade ◽  
High Grade ◽  
Core Needle ◽  
Image Guided ◽  
Efficient Alternative

PURPOSE The results of 106 radiologically guided core needle biopsies in 96 patients were analyzed retrospectively to evaluate the accuracy, safety, and role of this technique in the management of patients with lymphoma and to determine factors predictive of success. PATIENTS AND METHODS Biopsies were performed in 51 patients with low-grade non-Hodgkin's lymphoma (NHL), 24 with high-grade NHL, 16 with previously diagnosed Hodgkin's disease (HD), and 15 with no previous history of lymphoma. Disease was infradiaphragmatic in 92 patients and supradiaphragmatic in 14. Computed tomography (CT) guidance was used in 98 biopsies and ultrasonography (US) in eight. RESULTS The biopsy was diagnostic and yielded information on the basis of which treatment was started in 88 of 106 patients. The procedure was well tolerated and there were no major complications. Small size of the sample or inappropriate tissue sampled were the main causes of failure. The technique was equally successful in the diagnosis of HD and both high-grade and low-grade NHL as in nonlymphoproliferative disorders. The procedure was equally successful at diagnosis as at suspected recurrence or progression. In 33 of 80 cases in which the biopsy was performed at the time of recurrence or progression, the histology had changed; in 31 of 33, this influenced treatment. The technique was efficient at diagnosing transformation of follicular NHL in 16 of 18 patients, which allowed early adjustment of treatment at recurrence. CONCLUSION At St Bartholomew's Hospital (SBH), image-guided core-needle biopsy has proven to be a quick, safe, and efficient alternative to excisional biopsy in the evaluation of lymphoproliferative disorders at presentation, recurrence, or progression. It should become the procedure of choice for histologic sampling in the absence of peripheral lymphadenopathy.

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