Core needle biopsy (CNB) and fine-needle aspiration (FNA) are increasingly replacing excisional lymph node biopsy in the diagnosis of lymphomas. However, evaluation of CNB and FNA remains challenging owing to limited architectural information and the more detailed subclassification of lymphomas required by the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Our study is the largest study to assess diagnostic accuracy of CNB and FNA in conjunction with ancillary studies. We analyzed 263 cases and a diagnosis was established in 237, of which 193 were completely subclassified. In cases in which excisional biopsy was available as a reference for comparison, CNB and FNA had a sensitivity of 96.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 90%. CNB and FNA with ancillary studies represent a viable alternative in the diagnosis of lymphoma, as long as the number and size of cores for morphologic studies are not compromised.

This study attempts to identify factors that influence the success or failure of subclassifying 154 cases of neck lymphoma by ultrasound-guided core needle biopsy (UGCNB). Variables including age, gender, nodal size, cutting needle bore, number of core tissues obtained, presence of nodal necrosis or infarct, fragmentation of the specimens and subclassification of lymphoma were reviewed and statistically analyzed to check if they were related to the success of UGCNB. UGCNB was successful in subclassifying lymphoma in 138 (89.7%) cases, in diagnosing lymphoma in 11 (7.1%) and unsuccessful in diagnosing lymphoma in five (3.2%) cases. No complications were encountered. The factors leading to failure in subclassification included the presence of composite lymphoma (p = 0.001), nodal necrosis or infarct (p = 0.001) and insufficiency or fragmentation of the specimens (p < 0.001). UGCNB is a safe and efficient procedure in subclassifying lymphoma. It may obviate surgical biopsy in 89.7% of cases.

Challenges associated with the efficient and effective preparation of micro- and nanoscale (micro- and nanogram) clinical specimens for proteomic applications include the unmitigated sample losses that occur during the processing steps. Herein, we describe a simple "single-tube" preparation protocol appropriate for small proteomic samples using the organic cosolvent, trifluoroethanol (TFE) that circumvents the loss of sample by facilitating both protein extraction and protein denaturation without requiring a separate cleanup step. The performance of the TFE-based method was initially evaluated by comparisons to traditional detergent-based methods on relatively large scale sample processing using human breast cancer cells and mouse brain tissue. The results demonstrated that the TFE-based protocol provided comparable results to the traditional detergent-based protocols for larger, conventionally sized proteomic samples (>100 microg protein content), based on both sample recovery and numbers of peptide/protein identifications. The effectiveness of this protocol for micro- and nanoscale sample processing was then evaluated for the extraction of proteins/peptides and shown effective for small mouse brain tissue samples (approximately 30 microg total protein content) and also for samples of approximately 5000 MCF-7 human breast cancer cells (approximately 500 ng total protein content), where the detergent-based methods were ineffective due to losses during cleanup and transfer steps.

The aim of this study was to evaluate retrospectively the accuracy and reliability of CT-guided percutaneous biopsy as an alternative to surgical biopsy in a selected population of patients without superficial enlarged lymph nodes and a final diagnosis of malignant lymphoma at first presentation.

The results of 145 CT-guided needle biopsies in 137 patients with malignant lymphoma at its first presentation and without superficial enlarged lymph nodes were analyzed retrospectively. Biopsies were performed in 24 patients with Hodgkin's disease (HD) and 113 with non-Hodgkin lymphoma (NHL). Factors such as patient's sex, age, type of lymphoma and biopsy site were evaluated to detect factors that could influence the success rate of the procedure.

Biopsy specimens were diagnostic in 101 of the 113 patients with NHL and in 18 of the 24 patients with HD. Repeating of a previously nondiagnostic biopsy was successful in 7 out of 13 patients with NHL. No positive results were obtained, repeating the inconclusive biopsy in six patients with HD.

Our results suggest that percutaneous CT-guided biopsy is a useful and reliable tool in the diagnosis and classification of malignant lymphomas in patients without superficial lymphadenopathy and can be considered as an alternative to surgical sampling. However, little advantages were obtained, repeating previously inconclusive biopsies: In these cases, surgical sampling is mandatory.

To evaluate the diagnostic efficacy of image-guided cutting-edge-needle biopsy of peripheral lymph nodes and superficial masses for the diagnosis of lymphoma, for which many still advocate open surgical resection.

A retrospective analysis was performed of the medical records of 114 lymphoma patients who presented with peripheral lymphadenopathy and superficial masses and who underwent diagnostic image-guided biopsy. There were 69 non-Hodgkin lymphoma patients, 38 Hodgkin lymphoma patients, and 7 patients who were evaluated for histologic transformation of CLL or high grade lymphoma.

Image-guided needle biopsy was diagnostic in 96/114 (84.2%) patients. The procedure was diagnostic in 59/69 (85.5%) of NHL patients and in 30/38 of Hodgkin disease patients (79%). Diagnoses were achieved for all 7 cases where histologic transformation was suspected.

Percutaneous image-guided needle biopsy is a safe and reliable procedure with a high diagnostic yield. It can be used as a first step in patients suspected of having lymphoma presenting with enlarged peripheral lymph nodes and superficial masses.

To assess the efficacy of laparoscopy in the diagnosis of intra-abdominal lymphoma.

The medical records of patients with suspected primary or recurrent lymphoma who underwent laparoscopy between March 1991 and March 2003 were reviewed. Demographic, clinical, operative, and pathologic data were collected. The feasibility, safety, and effectiveness of the laparoscopic procedure were assessed.

Laparoscopic biopsy was attempted in 94 patients. In 78 patients (83%), the procedure was completed laparoscopically. Conversion to laparotomy was undertaken in 16 patients (17%), most commonly because of inadequate exposure, insufficient tissue, or postoperative adhesions. Among the 69 cases of lymphoma, 55 (80%) were diagnosed via laparoscopy only, 9 (13%) via laparotomy, and 5 (7%) with later procedures. Of the remaining 25 patients, 7 had nonlymphoma disease (4 occult carcinomas, 1 multiple myeloma, 1 epithelioid leiomyosarcoma, and 1 neuroblastoma), and 18 had benign lymphadenopathy (no evidence of lymphoma with a mean follow-up of 53 months). The laparoscopic procedure resulted in false-negative results in 6 patients (6%). The mean hospital stay for patients having a laparotomy was 6 days (range, 3-10 days); the remaining patients were all outpatients. The only Intraoperative laparoscopic complication was hemorrhage that required laparotomy. This event occurred in a patient with a previously undiagnosed neuroblastoma.

Laparoscopic lymph node biopsy safely provides adequate tissue for full histological evaluation on an outpatient basis in most patients with intra-abdominal lymphoma.

We retrospectively reviewed 74 fine-needle aspiration (FNA) cases of presumptive non-Hodgkin lymphoma (NHL). All the cases had cytology and core-needle biopsy and 53 cases had concurrent flow cytometric analysis. FNA (cytology and flow cytometry) and core-needle biopsy were evaluated independently. FNA was diagnostic of diffuse large B-cell lymphoma (DLBL) in 25% (13/53) of cases and small B-cell NHL in 15% (8/53) of cases, whereas core-needle biopsy was diagnostic of DLBL in 37% (27/74) of cases and small B-cell NHL in 8% (6/74) of cases. Subclassification of small B-cell NHL was reached in 3/6 cases by core-needle biopsy. Insufficient cases were observed in both FNA (47%; 25/53) and core-needle biopsy (28%; 21/74) groups. With the combination of FNA and core-needle biopsy, diagnostic cases of DLBL increased to 43% (32/74) and insufficient samples were reduced to 16% (12/74). There was no clear advantage in the diagnosis and classification of small B-cell NHL by adding core-needle biopsy to FNA (14%; 10/74). We conclude that core-needle biopsy is a useful adjunct to FNA in the diagnosis of DLBL and shall be encouraged. In small B-cell NHL, core-needle biopsy does not add to the diagnostic ability of FNA. Cases insufficient for diagnosis may be seen in both core-needle biopsy and FNA. A combined approach reduces the number of insufficient cases and is recommended in routine FNA practice.

Cytomorphology in conjunction with immunophenotypic characterization is becoming increasingly used for the primary diagnosis of non-Hodgkin's lymphomas (NHL). This combination is especially advantageous for the diagnosis of intra-abdominal and intrathoracic lymphomas, since unlike superficial lesions, open biopsy of deep-seated tissues is more invasive and more costly, and is associated with a higher risk. We report the cytologic and immunophenotypic features of intra-abdominal NHL obtained by fine-needle aspiration (FNA). Twenty-two cases of intra-abdominal lesions obtained by image-guided FNA where flow cytometry was also performed were reviewed. Of the 22 studied cases, 7 were classified as large-cell lymphoma, 5 as follicular center-cell lymphoma, 2 as small noncleaved-cell lymphoma, 2 as lymphoplasmacytoid lymphoma, one as small lymphocytic lymphoma, and one as marginal-zone lymphoma. In the remaining 4 cases where the immunophenotypic pattern was not definitive, the cytomorphologic features were of small cleaved cells in 3 cases and of mixed small cleaved and large cells in one case. We successfully classified 9 of the 10 patients on whom histologic confirmation was obtained. The successful primary classification of most intra-abdominal non-Hodgkin's lymphomas can be done with a combination of cytology and flow cytometry, and this can be the initial approach in patients with deep-seated lesions. Diagn. Cytopathol. 1999;21:98-104.

Hodgkin's disease (HD) is not currently included within the Centers for Disease Control (CDC) classification system for AIDS. Upon HD diagnosis, HIV(human immunosuppressive virus)-positive patients are generally found within Stages III or IV of the Ann Arbor HD classification system, already exacerbating the problem of treatment. In contrast, HIV-negative patients diagnosed with HD are generally found within Stages I or II. Epidemiology and the presence of secondary lymphomas, opportunistic infections, or aggressive pathologies, accompanied by low survival rate and timing of HD diagnosis suggest that HD should be included among conditions indicating AIDS manifestation.

In a retrospective analysis of 129 ultrasound-guided biopsy-gun biopsies (USGB) from patients with known or suspected malignant lymphoma, a histopathological diagnosis was obtained in 101 (78%) instances and no further procedures for histological verification were required. In the 28 cases with initially non-diagnostic results, 14 new USGBs were performed and a diagnosis was obtained in 11. Thus, a total success rate of 87% was achieved. The correct diagnosis was confirmed with either surgery, autopsy, or radiological or clinical follow-up (median 40 months). The diagnoses were categorised as Hodgkin's disease and high-grade or low-grade non-Hodgkin's lymphoma. Further subtyping of the lymphoma was possible in a few cases only. Immunohistochemistry was utilised only in a minor proportion of the cases (25/129), but refined the diagnosis in several instances. The biopsy-gun method was safe and minor adverse effects were seen in two patients only.

Because fine-needle aspiration biopsy (FNAB) is being increasingly used as a primary diagnostic tool, it is essential to obtain the maximum information from the aspirate. Electron microscopy is an adjunctive procedure that is readily applied to FNAB specimens. The value of electron microscopy to the cytopathologist was assessed by comparing the initial, tentative, or interim diagnosis based on light microscopic features with the diagnosis resulting from the ultrastructural characteristics of needle rinse material. Over a 3-year period, 279 FNAB specimens obtained under radiologic control were examined ultrastructurally; of these, 57 (20.4%) were considered inadequate specimens for diagnostic purposes. The remaining 222 FNAB specimens were segregated into four groups: 17 cases (7.7%) in which electron microscopy played a major role because the final diagnosis was unsuspected from light microscopy; 43 cases (19.4%) in which electron microscopy selected a specific diagnosis from a set of differential diagnoses or provided additional information that was clinically relevant; 45 cases (20.3%) in which additional diagnostic information was obtained by electron microscopy but was not clinically relevant; and 117 cases (52.6%) in which electron microscopy was not helpful because the light and electron microscopic diagnoses were the same. In this comparative study, electron microscopy provided a major contribution to the final cytologic diagnosis in 27.1% of the cases (groups 1 and 2). Descriptive examples illustrate how the architectural and cytologic features revealed by electron microscopy assist in establishing the final diagnosis. Examination of needle rinse specimens, particularly aspirates from lung and liver, indicates that most FNABs provide mini-surgical biopsy specimens that are well suited to ultrastructural examination.

Histological examination of adequate biopsy specimens is fundamental to the management of patients with non-Hodgkin's lymphoma (NHL). A practical alternative to open biopsy, provided enough tissue can be obtained, has obvious advantages, especially if the lesion in question is deep seated, and might call for laparotomy or thoracotomy. Core biopsy with computed tomography (CT) or ultrasound (US) guidance may be such an alternative, particularly when a spring-loaded firing device is used. Thirty-four biopsies were performed in 26 patients with known or suspected NHL. A primary histological diagnosis was made in 7/7 (six NHL, one seminoma). Relapse was confirmed in 15/15 patients overall. In patients with follicular NHL, 8/15 biopsies showed progression to high grade histology. Biopsies were also performed to assess the nature of residual abnormalities after treatment and to obtain fresh tissue for immunocytochemistry. Tissue was obtained in all cases and a further procedure (two laparotomies, one second needle biopsy) was required on only three occasions. The procedure was well tolerated and there were no complications. This technique is therefore a valuable alternative to more invasive surgical procedures and may be of major benefit in the management of NHL.

KS and non-Hodgkin's lymphomas frequently involve the gut in patients with AIDS. These neoplasms establish the diagnosis of AIDS in an HIV-positive patient. KS is a spindle-cell tumour derived from lymphatic endothelia which is associated with luminal lesions in at least 40% of patients. Gastrointestinal KS is usually asymptomatic but may rarely bleed or obstruct. Treatment of KS with either interferon-alpha, radiation or chemotherapy can reduce tumour bulk, but does not alter overall survival in AIDS. Non-Hodgkin's lymphomas in AIDS are B cell neoplasms with many genotypic and phenotypic similarities to Burkitt's lymphoma. The tumours are usually highly aggressive, and present in extranodal sites in the majority of cases. Of these extranodal sites, gastrointestinal involvement is most common. Gastrointestinal lymphomas are usually symptomatic and almost always require treatment. Obstruction, perforation and bleeding may occur in patients with luminal involvement, whereas hepatic or biliary disease may lead to jaundice. Several chemotherapeutic regimens for lymphoma have been successfully used to achieve partial remission, although no prolongation of survival has been demonstrated. There appears to be an increased incidence of Hodgkin's disease in patients with AIDS, which is generally of advanced stage. This tumour does not meet the CDC criteria for AIDS as yet. Hepatic and/or splenic involvement in this setting are common.