Improving resource utilization: Axillary lymph node core biopsy triaging for lymphoma

Area of Science:

• Pathology
• Oncology
• Diagnostic Imaging

Background:

• Axillary lymph node core biopsies (AxLNCB) are crucial in breast cancer staging.
• Hematopathology consultation is often sought for AxLNCB interpretation.
• The necessity and extent of hematopathology involvement require evaluation.

Purpose of the Study:

• To assess the utilization of hematopathology resources for AxLNCB specimens.
• To identify factors influencing hematopathology consultation for AxLNCB.
• To determine the actual prevalence of hematologic malignancies in AxLNCB.

Main Methods:

• Retrospective review of 594 AxLNCB specimens over 30 months.
• Analysis of hematopathology resource utilization (triage, review).
• Chart review for patient demographics and radiographic features.

Main Results:

• 61.6% of AxLNCB were benign, 38.6% malignant.
• Only 9.3% of malignant cases had hematologic malignancy.
• 94% of cases were triaged for lymphoma, 81% reviewed by hematopathologists.
• Six factors predicted hematologic malignancy risk: male sex, bilateral lymphadenopathy, diffuse cortical thickening, lack of breast cancer, older age, and prior hematologic malignancy history.

Conclusions:

• Significant overuse of hematopathology resources for AxLNCB was observed.
• A predictive tool based on clinical parameters can optimize hematopathology consultation.
• Improved resource allocation can enhance efficiency in evaluating AxLNCB.