title: Laparoscopy has a superior diagnostic yield than percutaneous image-guided biopsy for suspected intra-abdominal lymphoma.
abstract: BACKGROUND
  To date, no study has compared laparoscopy (LB) to percutaneous (PB) biopsy for the diagnosis of abdominal lymphoma. The objective of this study is to compare the success rate and safety profile of laparoscopic lymph node biopsy to the percutaneous approach in patients with intra-abdominal lymphadenopathy concerning for lymphoma.
  
  
  METHODS
  We performed a multi-institution, retrospective review of patients undergoing lymph node biopsy for suspected intra-abdominal lymphoma between 2005 and 2013. Our primary outcome was adequate tissue yield between the two techniques, both for histologic diagnosis and for ancillary studies such as flow cytometry. Secondary outcomes included 30-day morbidity, 30-day readmission rates, the need for additional lymph node biopsy procedures, and length of stay.
  
  
  RESULTS
  All 34 of the LB patients had adequate specimen for histologic diagnosis compared to 92.3% of patients with a PB (p = 0.18). Significantly more patients in the LB group had sufficient tissue for ancillary studies when needed than in the PB group, 95.5 and 68.2%, respectively (p = 0.04). A second biopsy was pursued in 23.1% of failed PB patients, 0% with success on second attempt.
  
  
  CONCLUSIONS
  When index of suspicion is high or when biopsy is performed for patient previously diagnosed with lymphoma and recurrence/transformation is suspected, LB safely and consistently provides adequate tissue for initial diagnosis and for ancillary studies. In contrast, image-guided PB may be more appropriate for patients for whom ancillary studies are unlikely to add to planned treatments or when there is a high risk of complications from either general anesthesia or patient comorbidities.
authors.affiliation: Rush University Medical Center, Chicago, IL, USA, shaun_daly@rush.edu.
authors.forename: Shaun C
authors.initials: SC
authors.lastname: Daly
authors.forename: Matthew
authors.initials: M
authors.lastname: Klairmont
authors.forename: Bulent
authors.initials: B
authors.lastname: Arslan
authors.forename: Yalini
authors.initials: Y
authors.lastname: Vigneswaran
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Roggin
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
authors.forename: Woody
authors.initials: W
authors.lastname: Denham
authors.forename: Keith W
authors.initials: KW
authors.lastname: Millikan
authors.forename: Minh B
authors.initials: MB
authors.lastname: Luu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Deziel
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Myers
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008223:Lymphoma / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies