Vassaliki I. Pappa

PURPOSE: The results of 106 radiologically guided core needle biopsies in 96 patients were analyzed retrospectively to evaluate the accuracy, safety, and role of this technique in the management of patients with lymphoma and to determine factors predictive of success. PATIENTS AND METHODS: Biopsies were performed in 51 patients with low-grade non-Hodgkin's lymphoma (NHL), 24 with high-grade NHL, 16 with previously diagnosed Hodgkin's disease (HD), and 15 with no previous history of lymphoma. Disease was infradiaphragmatic in 92 patients and supradiaphragmatic in 14. Computed tomography (CT) guidance was used in 98 biopsies and ultrasonography (US) in eight. RESULTS: The biopsy was diagnostic and yielded information on the basis of which treatment was started in 88 of 106 patients. The procedure was well tolerated and there were no major complications. Small size of the sample or inappropriate tissue sampled were the main causes of failure. The technique was equally successful in the diagnosis of HD and both high-grade and low-grade NHL as in nonlymphoproliferative disorders. The procedure was equally successful at diagnosis as at suspected recurrence or progression. In 33 of 80 cases in which the biopsy was performed at the time of recurrence or progression, the histology had changed; in 31 of 33, this influenced treatment. The technique was efficient at diagnosing transformation of follicular NHL in 16 of 18 patients, which allowed early adjustment of treatment at recurrence. CONCLUSION: At St Bartholomew's Hospital (SBH), image-guided core-needle biopsy has proven to be a quick, safe, and efficient alternative to excisional biopsy in the evaluation of lymphoproliferative disorders at presentation, recurrence, or progression. It should become the procedure of choice for histologic sampling in the absence of peripheral lymphadenopathy.

Background: DLBCL is the most common subtype of non‐Hodgkin's lymphomas. However, the pathogenesis of DLBCL is not fully understood. Transcription factors or signaling pathways involved in normal B cell development and function might represent future therapeutic targets. Such a transcription factor is MEF2 C contributing to B cell activation and germinal center formation. Aims: This study aims at investigating the role of MEF2 C as prognostic biomarker in DLBCL. Methods 82 patients with DLBCL were enrolled in our study. We assessed the expression of MEF2 C by performing immunohistochemistry (IHC) on paraffin slides of 62 tissue blocks and results were evaluated by using the H‐score semiquantitative approach, with a range from 0 to 300. Additionally, we analyzed clinical [sex, age, stage of DLBCL, performance status, extranodal sites, B symptoms, International Prognostic Index (IPI), age‐adjusted IPI, revised‐IPI, National Comprehensive Cancer Network (NCCN)‐IPI], laboratory [lactate dehydrogenase (LDH), hemoglobin (Hb), white blood cells (WBC), neutrophils, lymphocytes, monocytes, platelets and beta‐2‐microglobulin] and pathologic characteristics (CD10, BCL6, MUM‐1, Ki‐67) of patients in relation to overall (OS) and disease free survival (DFS). Results: Mean and median value of MEF2 C H‐score was 120 ± 58. We observed a statistical significant correlation with age (p= 0.021) and a tendency to correlate with LDH (p = 0.18). The expression of MEF2 C was not associated with other clinical or laboratory values. MEF2 C positivity >80% was correlated with borderline inferior OS (p = 0.083). Among patients, who survived more than 12 months after initial diagnosis, those with MEF2 C H score <120 had a significant better OS comparing with those with MEF2 C H score >120 (p = 0.009). Summary/Conclusion: High IHC expression of MEF2 C showed a negative prognostic influence in patients with OS more than 12 months after initial diagnosis. However, these results should be confirmed in larger groups of DLBCL patients and the underlying oncogenic mechanism of MEF2 C in DLBCL should be further explored.