Johl Alice, Lengfelder Eva, Hiddemann Wolfgang, Klapper Wolfram
Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Arnold-Heller-Str. 3, Haus 14, 24105, Kiel, Germany.
3rd Department of Internal Medicine, University Hospital Mannheim, Mannheim, Germany.
Ann Hematol. 2016 Aug;95(8):1281-6. doi: 10.1007/s00277-016-2704-0. Epub 2016 May 28.
Current guidelines of the European Society of Medical Oncology recommend surgical excision biopsies of lymph nodes for the diagnosis of lymphoma whenever possible. However, core needle biopsies are increasingly used. We aimed to understand the common practice to choose the method of biopsy in Germany. Furthermore, we wanted to understand performance of surgical excision and core needle biopsies of lymph nodes in the diagnosis of lymphoma. The files of 1510 unselected, consecutive lymph node specimens from a consultation center for lymphoma diagnosis were analyzed. Core needle biopsies were obtained frequently from lymph nodes localized in mediastinal, abdominal, retroperitoneal, or thoracic regions. Patients undergoing core needle biopsies were significantly older and suffered significantly more often from lymphoma than patients undergoing surgical excision biopsies. Although more immunohistochemical tests were ordered by the pathologist for core needle biopsies specimens than for surgical excision biopsies specimens, core needle biopsies did not yield a definite diagnosis in 8.3 % of cases, compared to 2.8 % for SEB (p = 0.0003). Restricting the analysis to cases with a final diagnosis of follicular lymphoma or diffuse large B-cell lymphoma, core needle biopsies identified a simultaneous low- and high-grade lymphoma (transformation) in 3.3 % of cases, compared to 7.6 % for surgical excision biopsies (p = 0.2317). In Germany, core needle biopsies are preferentially used in elderly patients with a high likelihood of suffering from lymphoma. Core needle appeared inferior to surgical excision biopsies at providing a definite diagnosis and at identifying multiple lymphoma differentiations and transformation.
欧洲医学肿瘤学会的现行指南建议，只要有可能，应通过手术切除淋巴结活检来诊断淋巴瘤。然而，粗针活检的应用越来越广泛。我们旨在了解德国选择活检方法的常见做法。此外，我们还想了解手术切除活检和粗针活检在淋巴瘤诊断中的表现。对一家淋巴瘤诊断咨询中心的1510份未经筛选的连续淋巴结标本档案进行了分析。粗针活检常用于纵隔、腹部、腹膜后或胸部区域的淋巴结。接受粗针活检的患者比接受手术切除活检的患者年龄更大，患淋巴瘤的频率也更高。尽管病理学家对粗针活检标本进行的免疫组化检测比对手术切除活检标本更多，但粗针活检在8.3%的病例中未能得出明确诊断，而手术切除活检的这一比例为2.8%（p = 0.0003）。将分析限制在最终诊断为滤泡性淋巴瘤或弥漫性大B细胞淋巴瘤的病例中，粗针活检在3.3%的病例中发现了同时存在的低级别和高级别淋巴瘤（转化），而手术切除活检的这一比例为7.6%（p = 0.2317）。在德国，粗针活检优先用于患淋巴瘤可能性高的老年患者。在提供明确诊断以及识别多种淋巴瘤分化和转化方面，粗针活检似乎不如手术切除活检。
