IMAGE‐GUIDED CORE BIOPSY IS SAFE AND EFFECTIVE FOR THE DIAGNOSIS OF LYMPHOMA

Abstract

Introduction: Excisional biopsy (EB) from nodal or extranodal sites is the standard technique to reach an accurate histological classification and to establish the definitive diagnosis of lymphomas. Advances in knowledge in flow cytometry, genetics and molecular analyses, image-guided core biopsy (IGCB) could be an alternative to EB in most cases. Methods: In this study, we compare the safety and efficacy for the diagnosis of lymphoma between image-guided core biopsy (IGCB) and excisional biopsy in 117 patients who have suspicious radiological findings of lymphoma and 32 hematology patients with a possible recurrence. 149 consecutive lymphoma patients diagnosed between January 2016 and December 2017 were analysed in this study. IGCB was carried out in 89 patients. Among them, ultrasonic-guided IGCB was performed in 45 patients and CT-guided IGCB in 44. EB was performed in 50 patients. The efficacy and safety of both techniques were analysed by standard statistical methods. Results: Nodal localization was mediastinal or abdominal (non-palpable) in 47 IGCB-diagnosed patients (52.8%), but only in 7 EB-diagnosed patients (14%). IGCB-analysed patients were older and had more comorbidities. Compared with EB, the diagnosis was faster and the treatment was initiated sooner in IGCB-analysed patients (table 1). Sample enough to be sent to pathology exam was obtained by IGCB in 89 patients (100%), to flow cytometry in 86 (96.6%), and to genetic analysis in 84 (94.4%). There was a complete concordance (100%) among the results obtained by flow cytometry, genetic and molecular analyses in those patients diagnosed by excisional biopsy, but only in 81 IGCB-diagnosed patients (91%). In 4 of those non concordant cases, the definitive diagnosis was further established by EB. The rate of complications was low with both techniques and no statistical differences were observed. Conclusions: IGCB is an effective and safe alternative to EB for lymphoma diagnosis. Compared with EB, IGCB may be even less risky for older patients that have associated comorbidities. Another advantage of image is that non palpable lymph nodes can be visualized and biopsied. IGCB is also faster, since avoids the waiting list for surgery, and allows starting the treatment sooner. Inconclusive diagnoses using IGCG were infrequent. In those ambiguous cases, EB may be used to definitely diagnose the patients. Severe pain that needed morphine treatment (1) Delayed healing process (1) Keywords: flow cytometry.