Abstract
IntroductionBiopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. Nevertheless, it requires hospitalization, availability of an operating room, and sometimes general anesthesia, and it is associated with several drawbacks. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be potentially used to drive biopsy to the most metabolically active area within a lymph node or extranodal masses.MethodsA study of diagnostic accuracy was conducted to assess the performance of a PET-driven needle biopsy in patients with suspect active lymphoma.ResultsOverall, 99 procedures have been performed: three (3.0%) were interrupted because of pain but were successfully repeated in two cases. Median SUVmax of target lesions was 10.7. In 84/96 cases, the tissue was considered adequate to formulate a diagnosis (diagnostic yield of 87.5%) and to guide the following clinical decision. The target specimen was a lymph node in 60 cases and an extranodal site in 36. No serious adverse events occurred. The sensitivity of this procedure was 96%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 75%.ConclusionPatients can benefit from a minimally invasive procedure which allows a timely and accurate diagnosis of lymphoma at onset or relapse.
Highlights
Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment
A core needle biopsy could not be performed due to anatomic reasons: in one case, the ureter was too close to the target lesion and could have been damaged during the procedure; in the latter case, the target abdominal mass rapidly reduced between the time of the first positron emission tomography (PET) scan and the biopsy, in this sense making the suspect of lymphoma extremely unlikely
Taking into account all the 96 completed procedures, that means all of those ending with tissue sampling, a lymph node was the target of the biopsy in 62.5% of the cases, and an extranodal site was chosen as the most relevant site in the remaining 37.5% of the cases
Summary
Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. The development of imaging-guided core needle biopsies has partly overcome these disadvantages [3, 4]: computed tomography (CT), ultrasound (US), and fluoroscopy-guided procedures are easy to perform, safe, less invasive than OIB, and cost-effective This is true when deep abdominal or thoracic lesions, as well as sites such as the skeleton or the spine, are concerned. For this reasons, imaging-guided techniques nowadays play an evergrowing role in the diagnosis of active disease in lymphoma patients, in whom any nodal district or potentially any extranodal site can be affected by the neoplastic tissue [5,6,7,8,9,10]
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