1. Lymphoid Pathology on Small Biopsies (FNA and Small Core) – Advantages and Limitations: Guidelines for Ancillary Studies According to Clinical Scenario and Morphology
- Author
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Anand S. Lagoo, Kathryn M. Hogan, and Kedar V. Inamdar
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gold standard (test) ,Disease ,medicine.disease ,Lymphoma ,Fine-needle aspiration ,Immunophenotyping ,Biopsy ,medicine ,Radiology ,business ,Clinical scenario ,Pathological - Abstract
As therapeutic options for various lymphomas have rapidly expanded in the last decade, accurate classification and prognostic stratification of common and uncommon lymphoma types are of utmost importance. The most recent WHO classification continues to emphasize morphology, immunophenotype, molecular genetic abnormalities, and clinical behavior as the necessary pillars for correct diagnosis. Surgical excisional biopsy (SEB) is both historically and currently the gold standard technique for morphological examination, but it requires more time and preparation, often with more extensive anesthesia with higher potential for medical complications. Because of this, elderly and/or frail patients may not be able to tolerate the stress of the procedure, particularly when abdominal, retroperitoneal, and thoracic masses are to be examined. Indeed, excisional biopsy may not be technically feasible in certain locations (e.g., retroperitoneal midline). Patients may want to avoid the discomfort and inconvenience associated with excisional biopsy and may prefer an alternative, even when it is not medically necessary. In response to these issues, over the last 25 years, there has been increasing utilization of fine needle aspiration (FNA) cytology and core needle biopsy (CNB) techniques for diagnostic screening of enlarged lymph nodes or other mass lesions suspected to harbor lymphomas, metastatic neoplasms, and reactive lymphadenopathies. We provide guidelines for appropriate handling of the limited specimens obtained by these “small biopsies” and suggest how to optimize the use of ancillary technics such as flow cytometry, immunohistochemistry (IHC), and molecular analysis, firstly, to differentiate reactive lesions from lymphomas and, secondly, to provide accurate classification and prognostic information. The ability to render a definite diagnosis according to the WHO classification on these “small biopsies” varies for different lymphoma types, and we discuss the limitations of these specimens for common lymphomas. In the second half of the chapter, the correct handling of small biopsies performed in previously diagnosed and treated patients is discussed. We emphasize the evaluation of these repeat biopsies for disease recurrence, disease progression, emergence of secondary pathological processes due to prior treatment, and presence of therapeutic targets for the second- and third-line treatments. The clinically crucial distinctions among lymphomas with overlapping features are mentioned, and guidance for issuing descriptive reports and for requesting additional material is provided.
- Published
- 2020
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