ORIGINAL ARTICLE CT-guided needle biopsy performed with modified coaxial technique in patients with refractory or recurrent lymphomas Francesco Gaudio & Pasquale Pedote & Annunziata Ferrante & Tommasina Perrone & Giuseppe Ingravallo & Amato Antonio Stabile Ianora & Giuseppe Angelelli & Giorgina Specchia Received: 17 August 2013 /Accepted: 8 April 2014 /Published online: 24 April 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract The aim of this study was to evaluate the role of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alter- native tool to surgical biopsy in patients with refractory or recurrent lymphomas. Between May 2005 and May 2012, 57 CT-guided CNB of deep lesions were performed in patients with a previous diagnosis of lymphoma and suspected for refractory or recurrent disease. A modified coaxial technique was used in all cases and multiple samples were obtained for histological and immunohistochemical studies. A diagnosis of lymphoma with specification of subtype according to the World Health Organization (WHO) classification was established in 30/57 cases (52.6 %). The previous diagnosis of lymphoma was confirmed in 27/57 patients (47.4 %), whereas histological progression in 3/57 (5.3 %) and other malignant neoplasms in 17/57 (29.8 %) were found. Lympho- ma without subtype specification was diagnosed in 6/57 (10.5 %), and no conclusive diagnosis could be established in 4/57 cases (7 %). Overall diagnostic accuracy was 82.5 %. In patients with a final diagnosis of malignant lymphoma, accuracy was 75 %. No complications occurred. Percutaneous CT-guided CNB is a safe, effective and reliable tool in the management of patients with refractory or recurrent lymphomas without superficial lymphadenopathy and can be considered as alternative to surgical sampling. Keywords Lymphoma . Core needle biopsy . Immunohistochemical Introduction Lymphomas are curable by chemotherapy, combined modal- ity therapy (chemotherapy plus radiotherapy) or radiotherapy alone. However, even after this treatment, 20–40 % of patients either progress during treatment or relapse following an initial remission [1–3]. Percutaneous computed tomography (CT)-guided fine nee- dle aspiration biopsy (FNAB) is a widely used procedure in the diagnosis and follow-up of neoplasms, having high accu- racy values ranging from 80 to 93 % and a low complication rate [4–6]. However, this technique has been shown to be less accurate in the diagnosis of lymphomas compared with other malignancies [4, 7–9]. Correct diagnosis of lymphoma re- quires, in addition to a morphological study, immunohisto- chemical and molecular analyses to define the exact histolog- ical type and, on this basis, establish the best therapeutic approach and prognostic significance [10]. For this reason, excisional biopsy of the entire lymph node is considered the gold standard [11]. In patients with suspected diagnosis of lymphoma, in the absence of superficial lesions, CT-guided core needle biopsy (CNB) has been suggested as a viable alternative to surgical intervention [12]. The aim of our study was to verify the effectiveness of CT-guided CNB performed with a modified coaxial technique in a group of patients with refractory or recurrent lymphomas. F. Gaudio (*) : T. Perrone : G. Specchia Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari Medical School, Bari, Italy e-mail: gaudio@ematba.uniba.it P. Pedote : A. Ferrante : A. A. S. Ianora : G. Angelelli Interdisciplinary Department of Medicine, Section of Radiology, University of Bari Medical School, Bari, Italy G. Ingravallo Department Pathology, University of Bari Medical School, Bari, Italy Ann Hematol (2014) 93:1559–1564 DOI 10.1007/s00277-014-2078-0