Stellenwert der sonographisch gesteuerten Stanzbiopsie in der Diagnostik der ungeklärten Lymphadenopathie - eine retrospektive Studie bei n=793 Patientenfällen

The gold standard for persistent lymph node enlargement is surgical lymph node extirpation. However, due to perioperative management, this method is very cost-, time- and personnel-intensive. An alternative method with a significantly faster solution and patient-friendly is the ultrasound-controlled lymph node biopsy. Properly applied, this minimally invasive clinical method offers a safe and low-risk extraction of tissue samples from sonographically conspicuous lymph nodes accessible for ultrasound-controlled puncture. In the present study, n=793 patient cases with persistent, unexplained lymphadenopathy were included over a period of more than nine years. All these cases were subjected to an ultrasound-controlled biopsy. In each patient case there was a documentation of the sonographic findings, histopathological results and the final diagnosis (as documented in the letter of discharge). Based on the histopathological results and the final diagnosis the data were analyzed regarding diagnostic accuracy. Overall, an adequate biopsy for a histological assessment was obtained in 98.6% of the cases. Although a further diagnostic procedure was performed in 12.9% by means of a rebiopsy or a surgical lymph node extirpation, a high diagnostic accuracy of 95.0% was found in this study. Diagnostic accuracy of 95.6% was also achieved in the diagnosis of lymphoma diseases. In summary, when looking at all data in n=766 cases of n=793 cases (96.6%) a correct diagnosis could be determined on the basis by ultrasound-controlled biopsy. There was no significant difference in the diagnostic accuracy between primary diagnoses and recurrent diagnoses (p=0.599). In addition, no significant difference could be found in the localization of the lymph nodes (peripheral vs. abdominal) (p=0.507) and in the lymph node size (<1cm or ≥1cm) (p=0.603). The ultrasound-controlled biopsy shows in the diagnosis of Hodgkin lymphomas certain weaknesses in the present study. Only a sensitivity of 88.7% could be determined. It could be increased by a higher number of punch biopsy from the individual lymph node. Since the method is subject of a high interobserver variability based on clinical experience. The investigating executors should have clinical experience, the knowledge in ultrasound diagnostics and also the handling of biopsy instruments to ensure a high diagnostic accuracy. Overall it can be demonstrated on the basis of the large amount of cases in the present study that an ultrasound-controlled lymph node biopsy, which is carried out by an experienced investigator, can be ensured with a high diagnostic accuracy in the histological processing of the obtained samples. Due to the low invasiveness with a low complication rate as well as the rapid availability due to low personnel and spatial effort the ultrasound-controlled lymph node biopsy can be recommended in the primary diagnosis of unexplained lymphadenopathies.