Diagnostic Value of Fine Needle Aspiration and Core Needle Biopsy ...

Hematopathology 100 Id: 72SA Diagnostic Value of Fine Needle Aspiration and Core Needle Biopsy for Initial Evaluation of Lymphoma Claire Murphy, Sindhu Cherian, MD, Rodney Schmidt, MD, PhD, Xueyan Chen, MD, PhD, University of Washington Medical Center, Seattle Cancer Care Alliance, Seattle, WA Fine needle aspiration (FNA) and core needle biopsy (CNB) are well-established techniques for diagnosis of various neoplasms. Although excisional biopsy is the gold standard for definitive diagnosis of lymphoma, FNA and CNB have been increasingly applied as the initial approach given the advantage of safety and cost. Here we investigate the utility of FNA and CNB as the initial procedure for evaluation of lymphoma. 175 patients were included by searching UWMC pathology database from 2004-2014 for patients with a diagnosis of lymphoma who had an initial FNA or CNB followed by a second diagnostic procedure (CNB or excisional biopsy). Of the 175 patients, 80 had an initial FNA and 95 had an initial CNB. Among the 80 patients with initial FNA, 19 (23.8%) had a definitive diagnosis of lymphoma (not classified), with classification by subsequent biopsies; 61 (76.2%) had either nondiagnostic cytology (21) or an equivocal diagnosis (atypical or suspicious, 40), with definitive diagnosis and classification by subsequent biopsies. Of the 94 patients with initial CNB, 42 (44.2%) had a definitive diagnosis of lymphoma with 17 classified (confirmed by second biopsies) and 25 not classified (classified in second biopsies); 53 (55.8%) had an equivocal diagnosis (atypical or suspicious) with definitive diagnosis and classification by second biopsies. Notably, flow cytometry was more commonly performed in cases with definitive diagnosis by initial procedure (65.6%) than cases with nondiagnostic or equivocal diagnosis by FNA (37.7%) or CNB (34.0%). No specific lymphoma subtypes were identified that required routine excisional biopsy. We conclude that CNB has advantage over FNA for diagnosis and classification of lymphoma, especially in combination with flow cytometry. Given the safety and relatively low cost in comparison to excisional biopsy, CNB is a powerful technique that can be used in initial evaluation of lymphoma. ©American Society for Clinical Pathology

Am J Clin Pathol 2014;142:A100