Sonography-Assisted Cutting Needle Biopsy in the Head and Neck for the Diagnosis of Lymphoma: Can It Replace Lymph Node Extirpation?

Objectives: Malignant lymphoma frequently present with cervical lymph node enlargement. Before adequate therapy can be instituted, appropriate biopsy specimens must enable definite subclassification of the disease. While lymph node extirpation, traditionally considered the gold standard in the diagnostic evaluation of lymphoma, is invasive, diagnoses from fine needle aspiration cytology are often clinically insufficient on which to base treatment decisions. The aim of this study was to evaluate the diagnostic accuracy of cutting needle biopsy (CNB) in the management of patients in whom lymphoma was diagnosed or suspected in the head and neck. Study Design: Prospective quality assessment study in an academic tertiary care medical center. Methods: A systematic clinicopathological follow-up study was performed over a period of 54 months, including the results of 347 CNBs in 160 patients with cervico-facial masses. Ninety-seven CNBs were done in 45 patients with malignant lymphoma as the final or the tentative diagnosis. Results: We experienced 100% success in obtaining high-quality tissue cores. The target lymph node was correctly sampled in 41 of the 45 patients. Within these 41 patients, no false positive or false negative results were recorded. Full subclassification of the disease with prompt institution of therapy was possible in 92.3% of the lymphoma patients. Conclusions: CNB proved to be a sufficient alternative to open biopsy with excellent diagnostic yield and clinical usefulness. We recommend this procedure as the initial diagnostic step in patients with suspected lymphoma, either at presentation or at recurrence, and advocate its use in peripheral lymphadenopatby of the neck.