Assessment of the Diagnostic Accuracy of Core Needle Biopsies in the Diagnosis of Lymphoma

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system. Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1st, 2016 to December 31st, 2019. All CNB and excisional biopsies were reviewed. Samples were deemed inadequate if they 1. Did not provide enough tissue for a diagnosis or 2. Were too limited to fully characterize the disease. We determined the accuracy of each biopsy type, as well as their diagnostic odds ratio using a Baptista-Pike model. Results: Excisional biopsy was found to be adequate 97% (328/339) of the time, while CNB was adequate 57% (67/122) of the time. The diagnostic odds ratio for CNB was found to be 0.03583 [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p \u3c0.0001 (Chi square). Discussion: Our results indicate that excisional biopsy should remain the standard of care in the diagnosis of lymphoma for most cases at TJUH. Based on this research, a quality improvement initiative is being implemented to increase the number of excisional biopsies done at TJUH, especially in easily accessible areas