Abstract accepted for online presentation at the ECR 2004 (European Congress of Radiology).
View Imaging features of metastases and local recurrence in surgically treated kidney cancer

Percutaneous image-guided lymph node biopsy in lymphoma:
tips and tricks

A. Guermazi (San Francisco/US), S. Guth (Strasbourg/FR), A. Gangi (Strasbourg/FR)

1. To describe percutaneous image-guided biopsy in patients with lymphoma.

2. To describe some alternatives, tips and tricks for when the procedure tends to be difficult...

Background

Open surgical biopsy has long been considered the conventional gold standard for obtaining thoracic and abdominal lymph node samples in patients with lymphoma, especially for the original diagnosis. However, this procedure can have significant complications. With advances in cytopathologic diagnostic techniques, percutaneous image-guided needle biopsy with its high overall accuracy has become the procedure of choice, and is taking a prominent place in the management of lymphoma in both adults and children. It is now considered a relatively painless, quick, safe, low cost, and valuable tool for patients with suspected or recurrent lymphomas. A well-planned and executed biopsy provides an accurate diagnosis and facilitates treatment. CT is a widely available imaging modality and allows image-guided needle biopsy in a large majority of patients. US-guided biopsy is an alternative method of guidance and at some institutions is the guidance technique of choice. 

Among all diseases that can be diagnosed by image-guided needle biopsy, lymphomas are probably the greatest challenge for the pathologist. Indeed, tissue sampling should allow not only diagnosis but also accurate subtyping of the disease prior to initiation of therapy. Moreover, it is sometimes difficult to differentiate lymphomas from other lymphoproliferative diseases, benign hyperplasia, primary tumors or metastases, or even infectious processes. Therefore, for many years patients with suspected lymphomas have undergone excisional lymph node biopsy rather than a needle biopsy (Silverman et al. 1994; Demharter et al. 2001).

In this exhibit, we will describe the technique and give some alternatives for when the procedure tends to be difficult, especially in posterior and/or deep-seated lymph nodes.

Conclusion

Percutaneous image-guided needle biopsy, as a minimally invasive procedure, is an effective alternative to surgical biopsy in the original diagnosis, recurrence or progression of lymphomas. It is also safe, quick, accurate and cost-efficient. It should be the first procedure performed in the diagnosis of lymphoma, except at easily accessible superficial neck, inguinal, and axillary nodal sites. It provides sufficient information for the diagnosis of and subsequent therapeutic decision to treat most cases of lymphoma. Importantly, it should be performed as part of a multidisciplinary team approach. A surgical approach to the thoracic or abdominal lymph nodes should be avoided as a first diagnostic procedure in patients with suspected or recurrent lymphoma, unless a previous percutaneous biopsy has failed or is contraindicated, or there is a high suspicion of Hodgkin disease. In such cases, video-assisted surgery should be implemented because of its high diagnostic yield and its low morbidity (cf next chapter). For the same reasons and because of its potential morbidity, open surgery should nowadays be banished as a diagnostic procedure in patients with lymphomas.