Related Experiment Video
Updated: May 9, 2026
A Simple and Rapid Protocol to Non-enzymatically Dissociate Fresh Human Tissues for the Analysis of Infiltrating Lymphocytes
Published on: December 6, 2014
Improving resource utilization: Axillary lymph node core biopsy triaging for lymphoma
Carl Dernell1, John Astle1, Abraham Bogachkov2
1Departments of Pathology, Medical College of Wisconsin, Milwaukee, WI, US.
Insights
Hematopathology resources were overused for axillary lymph node core biopsies (AxLNCB) in breast cancer screening. A predictive tool using patient characteristics could optimize resource allocation for these biopsies.
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.
Objectives:
To evaluate the utilization of hematopathology resources within our enterprise on axillary lymph node core biopsy (AxLNCB) specimens, particularly those obtained in the context of breast cancer screening.
Methods:
The utilization of hematopathology resources was determined for all AxLNCB specimens over a 30-month period from across our enterprise, and chart review was performed for select patient demographics and radiographic features. The AxLNCB cases with benign histology were reviewed for subtyping of histologic patterns.
Results:
Of the total 594 AxLNCB specimens, 61.6% were benign and 38.6% malignant. Of malignant cases, only 9.3% contained any hematologic malignancy, yet 94% of all cases received tissue triage for lymphoma, and 81% were reviewed at least in part by a hematopathologist. Six clinical parameters were found to independently predict risk of hematologic malignancy: male sex (P = .041), bilateral lymphadenopathy (P = .004), diffuse cortical thickening (P = .005), lack of breast cancer (P = .001), older age (P < .001), and history of hematologic malignancy (P < .001).
Conclusions:
Our enterprise overused hematopathology resources in the evaluation of AxLNCB performed in the study period. Our process could improve from the application of a simple tool generated from this cohort to predict percent risk of the specimen containing hematologic malignancy using patient characteristics easily found via routine chart review.
Related Concept Videos
01:16Primary Lymphoid Organs
The red bone marrow is a soft, spongy tissue nestled in the interior of long bones such as the humerus and femur. It is the site...
01:15Secondary Lymphoid Organs
The spleen is a vital organ in the lymphatic system, nestled in the upper left side of the abdomen. It is composed of two primary regions: the red pulp and the white pulp, each having distinct functions. The red pulp performs a significant role in blood filtration. It efficiently purges the blood of old or damaged red blood cells and...
01:23Detailed Structure and Function of Lymph Nodes
From a histological perspective, lymph nodes can be split into two main areas: the superficial cortex and the deep medulla. The outer cortex is populated by dendritic cells, macrophages, and B lymphocytes, which are densely packed into follicles. When these B-lymphocytes are presented...