Evaluation of pathological diagnosis using ultrasonography-guided lymph node core-needle biopsy / 中华医学杂志(英文版)

ABSTRACT

<p><b>BACKGROUND</b>Image-guided core-needle biopsy as a minimally invasive procedure has partially replaced excisional biopsy of the lymph node. However, it is still a great challenge to pathologists. The aim of this study was to survey and evaluate the accuracy of pathological diagnosis using the ultrasonography (US)-guided core-needle biopsy (CNB) of the lymph node.</p><p><b>METHODS</b>Lymph node CNBs of 1119 consecutive patients from the Chinese People's Liberation Army (PLA) General Hospital were reviewed retrospectively. Biopsies were performed following outpatient procedures with direct US guiding by using 18-gauge cutting needle. The tissues of CNB were prepared according to the routine paraffin embedding and hematoxylin-eosin staining. Ancillary studies, including acid-fast staining and immunohistochemical staining, were performed when necessary.</p><p><b>RESULTS</b>The age range was 1 year old to 85 years old. Locations of the lymph node were as follows cervical area (n = 482), clavicular region (n = 227), retroperitoneum (n = 150), axilla (n = 93), groin (n = 79), abdomen/mesentery (n = 44), submaxillary region (n = 33), postauricular region (n = 4), iliac fosa (n = 3), parotid (n = 2), hepatic hilar region (n = 1), and elbow (n = 1). The histological diagnoses were conclusive in 815 cases (73%) and inconclusive in 304 cases (27%). The conclusive cases mainly included metastatic carcinoma (n = 449), tuberculosis (n = 111), lymphoma/leukemia (n = 124), reactive hyperplasia (n = 87), and other rare diseases (n = 44). The reasons for inconclusive cases were insufficient material for diagnosis, noncompliance of outpatients, or crushing artifacts of tissues caused by operation.</p><p><b>CONCLUSIONS</b>US-guided CNB can obtain lymphoid tissues from nearly all parts of the body for diagnostic purposes. Conclusive pathological diagnosis can be made in most of cases when adequate material was provided. Besides metastatic carcinoma, lymphomas with special immunophenotype can be accurately diagnosed and subclassified by US-guided CNB.</p>