According to expert guidelines, lymph node surgical excision is the standard of care for lymphoma diagnosis. However, core needle biopsy (CNB) has become widely accepted as part of the lymphoma diagnostic workup over the past decades. The aim of this study was to present the largest multicenter inventory of lymph nodes sampled either by CNB or surgical excision in patients with suspected lymphoma and to compare their diagnostic performance in routine pathologic practice. We reviewed 32 285 cases registered in the French Lymphopath network, which provides a systematic expert review of all lymphoma diagnoses in France, and evaluated the percentage of CNB and surgical excision cases accurately diagnosed according to the World Health Organization classification. Although CNB provided a definitive diagnosis in 92.3% and seemed to be a reliable method of investigation for most patients with suspected lymphoma, it remained less conclusive than surgical excision, which provided a definitive diagnosis in 98.1%. Discordance rates between referral and expert diagnoses were higher on CNB (23.1%) than on surgical excision (21.2%; P = .004), and referral pathologists provided more cases with unclassified lymphoma or equivocal lesion through CNB. In such cases, expert review improved the diagnostic workup by classifying ∼90% of cases, with higher efficacy on surgical excision (93.3%) than CNB (81.4%; P < 10-6). Moreover, diagnostic concordance for reactive lesions was higher on surgical excision than CNB (P = .009). Overall, although CNB accurately diagnoses lymphoma in most instances, it increases the risk of erroneous or nondefinitive conclusions. This large-scale survey also emphasizes the need for systematic expert review in cases of lymphoma suspicion, especially in those sampled by using CNB.

中文翻译：

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淋巴结切除比核心活检提供更精确的淋巴瘤诊断：法国淋巴病网络调查。

根据专家指南，淋巴结手术切除是淋巴瘤诊断的标准护理。然而，在过去几十年中，空芯针活检 (CNB) 已被广泛接受为淋巴瘤诊断检查的一部分。本研究的目的是展示疑似淋巴瘤患者通过 CNB 或手术切除取样的最大多中心淋巴结清点，并比较它们在常规病理实践中的诊断性能。我们审查了在法国淋巴病网络中注册的 32285 例病例，该网络对法国所有淋巴瘤诊断进行了系统的专家审查，并评估了根据世界卫生组织分类准确诊断的 CNB 和手术切除病例的百分比。尽管 CNB 在 92 年提供了明确的诊断。3%，似乎是大多数疑似淋巴瘤患者的可靠调查方法，但仍不如手术切除确凿，后者提供了 98.1% 的明确诊断。CNB 的转诊诊断和专家诊断之间的不一致率 (23.1%) 高于手术切除 (21.2%；P = .004)，并且转诊病理学家通过 CNB 提供了更多未分类淋巴瘤或模棱两可的病变病例。在这种情况下，专家评审通过对约 90% 的病例进行分类改进了诊断检查，手术切除的疗效 (93.3%) 高于 CNB (81.4%；P < 10-6)。此外，手术切除反应性病变的诊断一致性高于 CNB (P = .009)。总体而言，尽管 CNB 在大多数情况下可以准确诊断淋巴瘤，但它增加了错误或不确定结论的风险。