Enhancing the diagnostic accuracy of core needle biopsy in patients with lymphoproliferative disorders by an optimized protocol

Purpose Surgical excision biopsy of lymph nodes stands as the gold standard for histological characterization of lymphoproliferative disorders (LD). However, contemporary clinical practice increasingly leans toward core needle biopsy (CNB). This study seeks to explore the factors influencing the diagnostic yield of CNB in LD. Material and Methods This unicentric retrospective study presents data from patients referred for suspicion of new or relapsing LD. All patients underwent image-guided CNB of the target lesion based on PET/CT findings. The primary endpoint was the diagnostic outcome, comparing the ability to achieve a definitive diagnosis according to international guidelines with CNB versus the necessity for subsequent excisional biopsy. Results We enrolled 478 consecutive patients undergoing CNB, categorized into two cohorts. Cohort A comprised patients who underwent CNB using 18-20G full-core Menghini needles, with a median macroscopic fragment dimension of 1 cm. Cohort B included patients who underwent CNB with 16-18G semiautomatic guillotine needles, with a median macroscopic fragment dimension of 1.5 cm. In cohort A, the rates of diagnostic and non-diagnostic (or non-sufficiently detailed) CNBs were 95 (73%) versus 35 (27%), respectively. In cohort B, these rates were 299 (86%) versus 49 (14%). Conclusion The type and size of the needle used for CNB, as well as the histologic variant of LD, emerged as factors influencing diagnostic yield and accuracy. Given the swiftness of CNB compared to surgical excision, optimizing this technique could streamline the diagnostic and therapeutic workflow for patients with suspected LD.