The Clinicopathologic Research Of Core Needle Biopsy In Diagnosis Of Malignant Lymphoma

BACKGROUND AND OBJECTIVE:In rencent years,the incidence of malignant lymphoma shows an obvious rising tendency in the world, and it's a common disease endangering people's health.As we know,different subtypes of lymphoma have the different characters in biology and prognosis,so the treatment principle is not same. In the past decades,excision biopsy is the main method to diagnosis of lymphoma because of the samples are adequate for histopathologic and related experiment. Actually, the majority of patients are being treated by radiotherapy and chemotherapy rather than undergo an excisional therapy,for definite diagnosis,they have to accept surgery biopsy. With the development of the minimally invasive examination,core needle biopsy(CNB) ususlly has been implemented to diagnose lymphoma in western country,it is a simple,safe, cost- effective diagnostic method,but the use of this technique in diagnosis lymphoma has seldom been discussed in the literature in our country. We will discuss the utilities and limits of CNB, and note the differential diagnosis by the morphology and immune phenotypic features,it will have consult value for pathologists,in the meanwhile, provide a theoretical basis for clinical applications.MATERIALS AND METHODS:We performed a retrospective analysis of 81 patients with the pathological diagnosis of lymphoma or lymphoid tissue dysplasia who underwent core needle biopsy in China-Japan union hospital of Jilin university between January 2003 and February 2010. 28 cases were outpatients, 53 cases were inpatients.The age range was 4 to 79 years, with a median age of 47 years old, while 50 cases were male, 31 cases were female, male to female ratio of 1.6:1, of which 75 cases is primary lymphoma, 6 cases is recurrent. Image-guided core needle biopsy were performed in all patients, utilizing either ultrasound(US) 73 cases or computed tomography(CT) 8 cases. Spring-loaded automatic biopsy gun (CR Bard, Inc., Covington, GA, USA) throw device was used,biopsy needle size varied,with predominantly 18G but some 16G or 20G,depending on the operator's decision by the location and size of the lesion. Examinations were performed with a Color doppler ultrasonography,which is Sonosope SSI-1000 produced by Kaili Company,using the probe frequency ranging from 2.5 to 3.75MHz at deep seated lesion,while 5.0 to 7.5 MHz at the superficial place, GE 16 or 64 detector CT is used occasionally.Biopsies were taken from various sites,including neck (28 cases), axilla (6 cases), groin (4 cases), breast (1 cases), chest wall (2 cases), abdominal wall (3 cases), mediastinum (15 cases), lung (3 cases), liver (1 case), kidney (1 case), abdomen cavity (2 cases), retroperitoneum(5 cases), pelvis (1 case), bone (8 cases), spinal canal (1 case). Specimens for history were fixed in 10% buffered formalin and were embedded in paraffin,consecutive section with 4μm thick,were stained with hematoxylin-eosin. Additional immunohistochemistry stains were performed depending on hematoxylin-eosin morphologic findings according to SP method,all of monoclonal immunohistochemistry antibodies,e.g. CD3,CD4, CD20,CD79a,CD15,CD30,ALK and EMA come from maixin biology limited company in Fuzhou. Double-blind method was used in this study,that is, unknown primary diagnosis, two pathologists observe the sections respectively, then analyse consistency of the both.In order to increase the credibility of the diagnosis, parallel tests were used to reduce the rate of missed diagnosis. According to 2008 World Health Organization(WHO) Classification of Tumours of Haematopoietic and Lymphoid Tissues, two patholigists have a review of the cases and give reclassification, the final diagnosis in all cases was determined by excision biopsy or the patient's clinical course including follow-up,then verify the accuracy of core needle biopsy diagnosis in further.By Kappa test, to analyse consistency of both, data was processed by SAS 8.0 software,P<0.05 as statistical standerd,multivariate stepwise logistic regression analysis was applied to study the influence of the patient-related factors (sexuality, age), lesion-related factors (size,location), specimen-related factors(character,pieces,length),guided equip- ment(CT or US) on the diagnostic assurance.RESULTS: (1) After review, 58 cases are diagnosed as lymphoma and 10 cases are uncertain diagnosis by both pothlogical doctor, 5 cases and 8 cases are diagnosed as lymphoma respectively. After the diagnosis of consistency test, it has a medium or high degree of consistency, no statistically significant difference (X2 = 0.69, P = 0.40> 0.05, Kappa value = 0.50). (2) Definite subclassification of lymphoma was made by CNB in 64 of the 81 patients (DLBCL in 29 patients, T-LBL in 3, B-SLL in 3, FL in 1, MALToma in 2, PTCL, NOS in 7, B-LBL in 1, Plasmacytoma in 8, cHL in 10); 7 cases only were diagnosed as lymphoma,with no histological subtype;10 cases of small lymphocyte proliferative lesions were inconclusive (of which four patients were confirmed by suigical biopsy, axillary in 1 patients, mediastinum in 3, abdominal cavity in 1, retroperitoneal in 1 are all outpatients and have no follow-up). In 53 inpatients, 44 had histological subtype; 5 cases only were diagnosed as lymphoma; four cases were diagnosed by excisional biopsy. All of inpatients had clinical therapy information and were considered correct. Diagnostic accuracy was 92%(49/53). There were no procedure-related complications. (3) Location(superficial or deep) is significantly correlated to the diagnostic assurance (regression coefficient =-1.6169, P = 0.0329 <0.05), superficial lesion shows the exact diagnosis,the difference was statistically significant; gender, age, guided equipment (ultrasound, CT), tumor size, specimen character(fragments, strip), the length of the specimens,and pieces of specimens are not the decisive factors for the diagnostic assurance of pathology.CONCLUSION: (1) CNB is an efficent method in diagnosis lymphoma, and definite subclassification could be established in most cases(90%),which is essential for choosing the appropriate therapy method. (2) CNB is a fast, minimally invasive,safe and economic technique for the evaluation of lymphoma and has a high rate of diagnostic accuracy,it can be used as first-line diagnostic technique. (3) The appropriate immunohistochemical antibodies related morphology, good HE and immunohistochemical staining sections are important for the correct diagnosis. (4) The specimen of the CNB is limited,and sometimes morphology could be changed because of the technical factors,so it is important to correlate clinical history,radiologic and other examonations when pathologist make a diagnosis.