75 Core needle biopsy targeting the viable area of deep‐sited dominant lesion verified by color Doppler and/or contrast‐enhanced ultrasound contribute to the actionable diagnosis of the patients suspicious of lymphoma Dr. Jian Li1, Mrs. Yu Wang1, Prof. Zhiming Li1, Mrs. Feifei Zuo1 1 Sun Yat‐sen University Cancer Center, Guangzhou, China Objectives: The accuracy of ultrasound guided core needle biopsy (US‐CNB) for lymphoma diagnosis requires improvement to satisfy the practitioners’ rely on this mini‐invasive approach for lymphoma management. Methods: Color Doppler flow imaging and/or contrast enhanced ultrasound were employed to select the viable target area on the dominant deep‐site lesions detected by computer tomography or poison‐emission tomography/computer tomography in the Viable‐targeting CNB procedure, Institutional Review Board approval was obtained for this trial, and informed consents were signed for the procedure of US‐CNB and CEUS. The recruited Patients were assigned to Viable‐targeting CNB on demand by specialists with signaling willingness, or were assigned to routine procedure with grey‐scale ultrasound evaluation and guidance (Routine CNB). The primary end‐point was the superiority of the accuracy of viable‐targeting CNB for clinically actionable diagnosis; second endpoints were complications, time consumption from CNB to actionable diagnosis, and cost‐effectiveness. Results: A total of 245 patients undergo Routine US‐CNB (N=120) or Viable‐targeting US‐CNB (N=125), and revealed 91 (91/120, 75.8%) and 112 (112/125, 89.6%) conclusive diagnoses, respectively (p=0.004, OR 0.846, 95%CI: 0.753‐0.952). 6 patients were excluded for non‐conclusive diagnose and loss of follow‐up, and 239 patients revealed final diagnoses with follow‐up at least 6 months. the diagnostic yields of Routine US‐ CNB and viable‐targeting US‐CNB according to the final diagnosis were 78.4% (91/116) and 91.1% (112/123) (p=0.006, OR 0.554, 95%CI: 0.333‐0.920). The yield of actionable diagnosis were 84.0% (84/100) and 91.8% (101/110) for lymphoma, 85.1% (80/94) and 92.3% (96/104) for NHL, 66.7% (4/6) and 83.3% (5/6) for HL, in the routine and viable‐targeting groups respectively. No significant difference in the minor complications and no major abdominal or thoracic complications were observed. Time consumption between CNB and actionable diagnosis of the Viable‐targeting group is less than that of Routine group. The estimated cost per true diagnosis of routine US‐CNB () is more expensive than that () of Viable‐targeting US‐CNB. And subgroup analysis found that most lymphomas with conclusive diagnosis in US‐CNB are with higher FDG‐avid SUV. Binomial logistic regression revealed that conclusive diagnosis of CNB is correlated with ancillary studies of the CNB samples. Conclusions: Targeting‐viable US‐CNB should replace the routine US‐CNB to be the initial approach for biopsy the dominant lesion suspicious of lymphoma. And if failed with inconclusive diagnosis in this procedure, surgical excisional biopsy should be considered to complete the diagnosis, other than repeated CNB.
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