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.
Highlights
In the case of clinical suspicion of lymphoma, the histological examination of lymphadenopathy is essential for defining a correct diagnosis and for developing a proper treatment plan [1]
Preoperative evaluation includes (1) a careful and through physical examination, i.e., palpation of superficial lymph node regions performed by a physician experienced in the management of patients with lymphoma; (2) gray-scale ultrasonography scans (US), i.e., a technology that is readily available in clinical practice and is considered to provide sufficient information for selecting the node to be biopsied [1, 2]; and (3) computed tomography (CT), performed to strengthen the suspicion of lymphoma [2]
Four patients (2.1%) undergoing power Doppler ultrasonography (PDUS)-guided core-needle cutting biopsy (CNCB) were excluded for inadequate samples
Summary
In the case of clinical suspicion of lymphoma, the histological examination of lymphadenopathy is essential for defining a correct diagnosis and for developing a proper treatment plan [1]. Preoperative evaluation includes (1) a careful and through physical examination, i.e., palpation of superficial lymph node regions performed by a physician experienced in the management of patients with lymphoma; (2) gray-scale ultrasonography scans (US), i.e., a technology that is readily available in clinical practice and is considered to provide sufficient information for selecting the node to be biopsied [1, 2]; and (3) computed tomography (CT), performed to strengthen the suspicion of lymphoma [2]. Ann Hematol (2017) 96:627–637 nonpalpable but histologically significant malignant lymph nodes may impair the success of an OSB. Another limitation is mostly related to patients whose conditions may be too unstable for undergoing general anesthesia and surgical intervention [3]. New mini-invasive approaches to this procedure based on imaging-guided methods are available
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
