Shaun C Daly, MD, Matthew Klairmont, BS, Bulent Arslan, MD, Minh B Luu, MD, Jonathan A Myers, MD. Rush University Medical Center.
Introduction: Optimal treatment of lymphoma requires an accurate tissue diagnosis. Immunohistochemistry and flow cytometry are the most common studies required for diagnosis and uniquely require more viable tissue than other malignancies to diagnose. Our objective was to compare the diagnostic yield of a laparoscopic biopsy to image-guided percutaneous biopsy for lymphoma. The primary end-point was successful retrieval of adequate tissue specimen for a definitive pathologic diagnosis.
Methods: Records of patients who underwent laparoscopic and image-guided percutaneous lymph node biopsies for suspected cases of lymphoma at a large urban medical center over a 3- year period were reviewed. All patients demonstrated CT scan findings of intra-abdominal lymphadenopathy or a soft tissue mass >2 cm. All patients required intra-abdominal tissue retrieval because of the absence of peripheral adenopathy amenable to a less invasive approach. Patient demographics, complications, length of stay and diagnostic yield were analyzed.
Results: Fifty-three biopsies were performed between 2010 and 2012 and were included in the study. Twenty-seven biopsies were performed laparoscopically while twenty-six were performed by a percutaneous technique. Demographics did not differ between cohorts. No significant procedural complications occurred in either cohort. Most patients in each cohort were discharged the day of intervention. Overall, 96.3% of laparoscopic biopsies were successful in obtaining an adequate specimen for definitive pathologic diagnosis and subtyping compared to 65.4% of percutaneous biopsies (p=0.004). Among the failed percutaneous biopsies, 23% required a subsequent biopsy attempt.
Conclusion: In cases of suspected lymphoma, the diagnostic yield of laparoscopic lymph node biopsy is superior to an image-guided percutaneous approach. In cases of suspected lymphoma, when a greater amount of viable tissue is needed for an accurate diagnosis, a significant number of patients may be spared multiple interventions if first referred for diagnostic laparoscopy; reserving image-guided percutaneous techniques for cases when significant viable tissue is not required.