Portada Simposios - Supplements - Haematologica

306 Haematologica (ed. esp.), volumen 85, supl. 2, octubre 2000
Core-needle biopsy of mediastinal
lymph nodes
As most lymphoma diagnosis do not need heavy
surgical procedures, still there are cases in which the
only way to get access to an inner primary mass is
felt to be an operation. However, in an effort to ease
patient resistance to the invasive approach, without
loosing diagnostic accuracy, a number of less invasive
techniques have been explored first and improved
lately. Among them, core-needle biopsy of masses
localized in the anterior mediastinum has come
into its own. As cutting needles have been progressively
employed more frequently, in order to privilege
the greater reliability of histology compared to cytology,
several types of guidance of the needle have
also been studied, namely fluoroscopic, ultrasonographic
and computed tomographic 10 .
Our own experience 11 is based on retrospective
data referring to 260 patients who presented with
primary anterior mediastinal masses between 1985
and 1997. Of the 83 patients who ended up with a
diagnosis of lymphoma, 67 had undergone just the
core-needle biopsy, whereas in 13 cases this technique
had proven insufficient and the diagnosis was
generally obtained through either mediastinoscopy
or mediastinotomy. Notably, in most patients
core-needle biopsy sufficed to provide enough material
for histotype definition, as globally core-needle
biopsy allowed a fully reliable and less invasive diagnosis
in 22 of 30 (74 %) cases of HD and in 45 of
53 (85 %) cases of NHL. All the 83 biopsies were performed
using a Menghini needle (1.2-1.8 mm) with
either fluoroscopic (75 cases) or CT (8 cases) guidance.
We conclude that core-needle biopsy should always
be considered the first diagnostic option for
patients with primary mass of the anterior mediastinum
in terms of balance of factors such as accuracy,
risks, morbidity, discomfort and costs.
Core-needle biopsy of abdominal
lymph nodes
Another region of the body hard to get access to
with respect to primary mass diagnosis is certainly
the abdomen. Even more so, in the abdomen the
problem may arise both at the time of diagnosis and
concomitant with a possible relapse. Recent reports
tend to support the idea that core-needle biopsy
might be as potentially useful below the diaphragm
as it is above.
Our own data 12 refer to 55 lymphoma patients
who underwent ultrasound-guided core-needle
biopsy of abdominal lymph nodes between 1989
and 1996. Of them, 41 had not been previously
diagnosed as having any malignancy, while 14 were
already known as lymphoma patients (9 NHL and
5 HD). Among the 55 patients, 53 were subsequently
treated based upon the core-needle biopsy
findings only, including all 14 previously-diagnosed
lymphoma patients. The overall reliability of the ultrasound-guided
core-needle biopsy below the
diaphragm was 100 % among HD patients and 94 %
among NHL patients, with only 2 of the latter’s needing
other procedures to reach a diagnosis. It is noteworthy
that in 46 of the 53 patients (87 %) it was
possible to assess the specific histotype. All biopsies
were performed using a 21-gauge modified Menghini
needle.
Similarly to what we concluded with respect to the
core-needle biopsy of anterior mediastinal lymph
nodes, we think that for possible abdominal localizations
of lymphoma, in the absence of any other
more accessible lesion, this technique should be
considered as the first option, limiting the recourse
to surgery to selected cases for which a clear-cut
diagnosis cannot be achieved otherwise.
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