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

BACKGROUND: Inadequate accuracy of ultrasound-guided core needle biopsy (US-CNB) urges further improvement for the diagnosis and management of lymphoma to meet with the practitioners’ increased reliance on this mini-invasive approach. METHODS: Data related to US-CNB of the deep-sited dominant lesions suspicious of lymphoma detected by computer tomography or positron-emission tomography/computer tomography for eligibility assessment of three prospective clinical trials were collected in advance. A retrospective analysis of the prospective data collection was performed, in which Viable-targeting US-CNB that Color Doppler flow imaging (CDFI) and/or contrast enhanced ultrasound (CEUS) were employed to select viable area for biopsy target compared with Routine US-CNB that routine procedure of evaluation and guidance using gray-scale ultrasound with CDFI in terms of the yield of clinically actionable diagnosis and safety, and determinants for the successful US-CNB that established an actionable diagnosis were explored. The establishment of final diagnosis was based on surgical pathology or medical response to therapy with follow-up at least 6 months. RESULTS: A total of 245 patients underwent Routine US-CNB (N = 120) or Viable-targeting US-CNB (N = 125), of which 91 (91/120, 75.8%) and 112 (112/125, 89.6%) were revealed with actionable diagnoses, respectively (p = 0.004, OR 0.846, 95% CI: 0.753–0.952). And 239 patients established final diagnoses. Diagnostic yields of actionable diagnosis according to the final diagnoses were 78.4% (91/116) and 91.1% (112/123) (p = 0.006, OR 0.554, 95% CI: 0.333–0.920), 82.6% (90/109) and 92.5% (111/120) for malignancy, 84.0% (84/100) and 91.8% (101/110) for lymphoma, 85.1% (80/94) and 92.3% (96/104) for Non-Hodgkin Lymphoma, 66.7% (4/6) and 83.3% (5/6) for Hodgkin Lymphoma in Routine and Viable-targeting CNB groups, respectively. No major complications were observed. Dominant lesions with actionable diagnosis in US-CNB were with higher FDG-avid Standardized Uptake Value. Binomial logistic regression revealed that actionable diagnosis of US-CNB was correlated with group and ancillary studies. CONCLUSION: Viable-Targeting US-CNB was superior to routine US-CNB in term of the yield of actionable diagnosis for deep-sited dominant lesions suspicious of lymphoma, which demonstrated a potential to be the initial approach in this setting.