Contributions
Abstract: EP559
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Incidental or symptomatic abnormalities in the spleen can be found in a large spectrum of diseases. In most cases a diagnosis can be reached without splenic histology. Image-guided core biopsy of the spleen would be helpful in selected cases but is performed less often due to the perceived bleeding risk and low diagnostic utility.
Aims
To assess the diagnostic yield and safety of the image-guided splenic biopsy performed between January 2011 and October 2020 at 2 centres.
Methods
Retrospective data of all image-guided splenic biopsies performed at Colchester Hospital and Ipswich Hospital over 10 years were reviewed
Results
A total of 41 splenic biopsies were performed in 38 patients- 20 male and 18 female patients. The mean age was 66.5 years. The mean platelet count was 198 x 109/L (range 27 x 109/L – 558 x109/L). Only one patient received a prophylactic platelet transfusion. All biopsies were performed under ultrasonographic guidance. For the forty-one procedures 18-gauge needles were used in 90.2%, 16-gauge in 7.4% and 20-gauge in 2.4%. The mean number of core biopsy samples obtained were 3 (range 1-5 cores). 4 patients subsequently had elective splenectomy.
Adequate tissue for histological analysis including immunohistochemistry was obtained in 38 procedures (92.6%). Lymphoproliferative disorder was confirmed in 17 patients and was suspected in further 2 cases. These 2 patients later underwent splenectomy which confirmed the initial suspicion of DLBCL and low grade lymphoma. Of the 17 confirmed cases, DLBCL (10 cases) was the most frequent diagnosis and the remaining included 2 cases each of low grade B cell lymphoma, Hodgkin lymphoma, T-LGL and one case of T-cell rich B cell lymphoma. Non-haematological neoplasm was diagnosed in 4 patients. These included 2 cases of metastatic adenocarcinoma, 1 case of metastatic testicular germ cell tumour and 1 case of Littoral cell angioma.
Other histological diagnoses included 6 cases with reactive changes, 3 cases of sarcoidosis and one case each of Leishmaniasis, necrotising granulomata and extra-medullary haematopoiesis. A patient with reactive changes on splenic biopsy had features of extramedullary haematopoiesis identified on a subsequent splenectomy. Of the 5 remaining patients with reactive changes, 3 were discharged, 1 patient was later diagnosed to have chronic liver disease and 1 case remains under annual follow up.
Sufficient splenic tissue was not gained in 3 procedures (7.4%). 2 of these patients were later diagnosed to have low grade lymphoma – one following splenectomy and the other subsequent to molecular anaylsis of blood. The remaining patient with insufficient tissue declined further investigations. Three patients underwent a second splenic biopsy. The initial sample in these cases were deemed adequate but proved non diagnostic. The second biopsy secured a diagnoses of DLBCL, Hodgkin lymphoma and sarcoidosis in these patients.
1 patient developed peri-splenic haematoma which required an overnight admission for blood transfusion. This patient with thrombocytopenia (27 x 109/L) and a normal coagulation screen underwent a splenic biopsy using a 16-gauge needle following a single prophylactic platelet transfusion.
Conclusion
This case series demonstrates that ultrasound guided splenic biopsy by an experienced operator using a 18-gauge needle is a straight forward and minimally invasive procedure with a low complication rates and a high diagnostic yield.
Keyword(s):
Abstract: EP559
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Incidental or symptomatic abnormalities in the spleen can be found in a large spectrum of diseases. In most cases a diagnosis can be reached without splenic histology. Image-guided core biopsy of the spleen would be helpful in selected cases but is performed less often due to the perceived bleeding risk and low diagnostic utility.
Aims
To assess the diagnostic yield and safety of the image-guided splenic biopsy performed between January 2011 and October 2020 at 2 centres.
Methods
Retrospective data of all image-guided splenic biopsies performed at Colchester Hospital and Ipswich Hospital over 10 years were reviewed
Results
A total of 41 splenic biopsies were performed in 38 patients- 20 male and 18 female patients. The mean age was 66.5 years. The mean platelet count was 198 x 109/L (range 27 x 109/L – 558 x109/L). Only one patient received a prophylactic platelet transfusion. All biopsies were performed under ultrasonographic guidance. For the forty-one procedures 18-gauge needles were used in 90.2%, 16-gauge in 7.4% and 20-gauge in 2.4%. The mean number of core biopsy samples obtained were 3 (range 1-5 cores). 4 patients subsequently had elective splenectomy.
Adequate tissue for histological analysis including immunohistochemistry was obtained in 38 procedures (92.6%). Lymphoproliferative disorder was confirmed in 17 patients and was suspected in further 2 cases. These 2 patients later underwent splenectomy which confirmed the initial suspicion of DLBCL and low grade lymphoma. Of the 17 confirmed cases, DLBCL (10 cases) was the most frequent diagnosis and the remaining included 2 cases each of low grade B cell lymphoma, Hodgkin lymphoma, T-LGL and one case of T-cell rich B cell lymphoma. Non-haematological neoplasm was diagnosed in 4 patients. These included 2 cases of metastatic adenocarcinoma, 1 case of metastatic testicular germ cell tumour and 1 case of Littoral cell angioma.
Other histological diagnoses included 6 cases with reactive changes, 3 cases of sarcoidosis and one case each of Leishmaniasis, necrotising granulomata and extra-medullary haematopoiesis. A patient with reactive changes on splenic biopsy had features of extramedullary haematopoiesis identified on a subsequent splenectomy. Of the 5 remaining patients with reactive changes, 3 were discharged, 1 patient was later diagnosed to have chronic liver disease and 1 case remains under annual follow up.
Sufficient splenic tissue was not gained in 3 procedures (7.4%). 2 of these patients were later diagnosed to have low grade lymphoma – one following splenectomy and the other subsequent to molecular anaylsis of blood. The remaining patient with insufficient tissue declined further investigations. Three patients underwent a second splenic biopsy. The initial sample in these cases were deemed adequate but proved non diagnostic. The second biopsy secured a diagnoses of DLBCL, Hodgkin lymphoma and sarcoidosis in these patients.
1 patient developed peri-splenic haematoma which required an overnight admission for blood transfusion. This patient with thrombocytopenia (27 x 109/L) and a normal coagulation screen underwent a splenic biopsy using a 16-gauge needle following a single prophylactic platelet transfusion.
Conclusion
This case series demonstrates that ultrasound guided splenic biopsy by an experienced operator using a 18-gauge needle is a straight forward and minimally invasive procedure with a low complication rates and a high diagnostic yield.
Keyword(s):