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Image-guided percutaneous core needle biopsy of pathologic lymph nodes, a safe and effective alternative to surgery for diagnosis and subclassification of malignant lymphomas : A single institution 4-year experience

Background : Current guidelines of French National Authority for Health (HAS) and the European Society of Medical Oncology (ESMO), recommended surgical excision for the diagnosis and subtyping of lymphoma.

Purpose : The aim of this study was to compare from a retrospective cohort, medical conditions, safety and accuracy of surgical lymph node excision and image-guided core biopsy for the diagnosis and the subclassification of lymphoma.

Materials and Methods : We retrospectively reviewed all consecutive patients suspected for initial or recurrent lymphoma referred for percutaneous or surgical biopsy between January 2016 and January 2020 in a single center. This observational study included superficial or deep lymphadenopathy. Radiological, surgical and multidisciplinary meeting reports were reviewed to collect population characteristics. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated to evaluate the performance in the detection and subclassification of malignant lymphomas in both groups.

Results : 212 patients were included with 91 image-guided core needle biopsies and 121 surgical excisions. Significant differences between biopsy and surgery patients were age (60 ± 21 y.o vs 51 ± 24 p=0.01), suspicion of lymphoma recurrence (42.9% vs 20.7%, p=0.0008), superficial location (49.5% vs 92.6, p <0.0001), mean duration (18 min vs 42 min p<0.0001), and outpatient ( 68.7% vs 44.6% p=0.001). Biopsy sensitivity was 95.9% (95% CI [88.5, 99.1]), specificity 100% (95% CI [80.5, 100]), and accuracy 96,7% (95% CI [90.6, 99.3]) for lymphoma diagnosis versus 100 % (95% CI [95.2, 100]), 97.8% (95% CI [88.5, 99.9]), 99.2% (95% CI [95.5, 100]) for surgery. For subclassification the sensitivity and accuracy in the biopsy group were 79.5 % (95% CI [68.4, 88]), 83.3% (95% CI [74, 90.4]) versus 90.7 % (95% CI [81.7, 96.2]), 93.4% (95% CI [87.4, 97.1]) for surgery. The biopsy performance was not dependent on target depth, location even inguinal area. Biopsy is a safe procedure with 4.4% of complication and patients can be managed on an outpatient basis (68.7 % vs 44.6% p=0.001).

Conclusion : Image-guided core biopsy is a safe and accurate mini invasive procedure for the diagnosis of lymphoma and its subclassification and should be proposed as first-line technique.

Keywords : lymphoma, image-guided biopsy, performance diagnosis, surgical excision biopsy.