Skelton E, Jewison A, Okpaluba C, Sallomi J, Lowe J, Ramesar K, Grace R, Howlett D C
Department of Radiology, East Sussex Healthcare NHS Trust, UK.
Department of Radiology, East Sussex Healthcare NHS Trust, UK.
Eur J Surg Oncol. 2015 Jul;41(7):852-8. doi: 10.1016/j.ejso.2015.04.015. Epub 2015 May 5.
Current European Society for Medical Oncology (ESMO) guidelines recommend that when feasible, surgical excision biopsy (SEB) is the ideal for diagnosis, sub-typing and grading of malignant lymphoma. We undertook this retrospective study to assess the diagnostic accuracy of image-guided core needle biopsy (CNB) in the diagnosis of malignant lymphoma, to identify the proportion of cases from which oncological treatment was subsequently instigated from the CNB diagnosis, and to evaluate the potential role for minimally invasive CNB techniques in the diagnostic pathway of malignant lymphoma.
All cases of lymphoma amenable to CNB between 2008 and 2013 were included. Patient records were reviewed to identify the biopsy diagnostic pathway undertaken (fine needle aspiration cytology, CNB, surgical excision biopsy). CNB specimens were graded as fully diagnostic (tumour sub-typing/grading and treatment initiated), partially diagnostic (diagnosis of lymphoma but more tissue required for sub-typing/grading), equivocal or inadequate. The effects of anatomical location, needle gauge, number of core specimens and sub-type of disease on the diagnostic yield of the sample were analysed.
262 patients and 323 biopsy specimens were included in the study. 237 patients underwent CNB as the initial diagnostic intervention. In 230/237 CNB was fully diagnostic (97%), allowing initiation of treatment. In 7 patients, SEB was necessary in addition to CNB to provide additional diagnostic information to allow initiation of treatment. In 72 patients, SEB was the only diagnostic test performed.
Our study showed that in 97% of suitable cases, CNB provided sufficient diagnostic information to allow treatment of malignant lymphoma to be instigated. This minimally-invasive technique is well tolerated and has advantages over surgical techniques, including reduced costs, post-procedural complications and delays on the diagnostic pathway. CNB may obviate the use of surgical techniques in the majority of suitable cases, however its success is dependent on close collaboration and acceptance by clinicians and pathologists.
当前欧洲医学肿瘤学会（ESMO）指南推荐，在可行的情况下，手术切除活检（SEB）是恶性淋巴瘤诊断、亚型分类及分级的理想方法。我们开展这项回顾性研究，以评估影像引导下粗针穿刺活检（CNB）在恶性淋巴瘤诊断中的诊断准确性，确定基于CNB诊断随后启动肿瘤治疗的病例比例，并评估微创CNB技术在恶性淋巴瘤诊断流程中的潜在作用。
纳入2008年至2013年间所有适合进行CNB的淋巴瘤病例。回顾患者记录，以确定所采用的活检诊断途径（细针穿刺抽吸细胞学检查、CNB、手术切除活检）。CNB标本分为完全诊断性（肿瘤亚型分类/分级及开始治疗）、部分诊断性（淋巴瘤诊断，但亚型分类/分级需要更多组织）、可疑或不充分。分析解剖位置、针径、芯针标本数量及疾病亚型对样本诊断率的影响。
本研究纳入262例患者及323份活检标本。237例患者以CNB作为初始诊断干预措施。在237例患者中，230例（97%）的CNB为完全诊断性，可启动治疗。7例患者除CNB外还需要SEB以提供额外诊断信息来启动治疗。72例患者仅进行了SEB作为诊断检查。
我们的研究表明，在97%的合适病例中，CNB提供了足够的诊断信息以启动恶性淋巴瘤的治疗。这种微创技术耐受性良好，与手术技术相比具有优势，包括成本降低、术后并发症减少以及诊断流程延迟减少。在大多数合适病例中，CNB可能无需使用手术技术，然而其成功取决于临床医生和病理学家的密切合作与认可。
