Original articleSkin biopsy in the diagnosis of intravascular lymphoma: A retrospective diagnostic accuracy study
Section snippets
Methods
We used our electronic registry to search pathology reports to find patients in whom a skin biopsy was performed as part of an evaluation for IVL at the Massachusetts General Hospital between January 1985 and March 2018. The study was approved by the Massachusetts General Hospital Institutional Review Board with a waiver of informed consent.
Study sample
We identified 56 patients who underwent a skin biopsy as part of an evaluation for IVL. The skin biopsy in 50 of these patients was performed as part of a diagnostic evaluation for suspected IVL. The disease was eventually diagnosed in 6 of these 50 patients. The skin biopsies in the remaining 6 patients were performed after the diagnosis of IVL had already been made by other means, typically a brain biopsy. We therefore had a total of 12 patients with IVL. All identified patients were
Discussion
In our cohort of 50 patients being evaluated for IVL in a Western academic hospital, 6 were eventually diagnosed with the disease, 5 of which were by skin biopsy samples. Our findings provide evidence that skin biopsy is a good diagnostic test to both rule in and rule out such a rare condition, with 1 positive result for every 10 patients evaluated for IVL. This finding contrasts with the lack of positive skin biopsy results among the 21 patients evaluated by Cho et al5 in another Western
Conclusions
The diagnostic yield of skin biopsy samples as part of an investigation for IVL in a tertiary referral Western hospital was higher than would be expected given the rarity of the disease and its pleomorphic presentation. A thorough approach when performing skin biopsies should be considered given the only moderate sensitivity of the method, especially when biopsies are limited to clinically uninvolved skin. Sampling normal skin in at least 3 sites, skin lesions, and angiomas, when present, is a
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2022, JAAD InternationalCitation Excerpt :Second, there were differences in the biopsy techniques, such as punch or incisional biopsy. However, no clear differences have been noted in the positive detection rates of RSB between punch and incisional biopsies,8,9,11-13 as was also shown in this study. Third, the sampling sites for RSB were not always taken from skin lesions.
Predictive factors and scoring system for intravascular large B-cell lymphoma among suspected cases: a single-center retrospective analysis
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Daniel Rozenbaum, MD, and Joe Tung, BS, are cofirst authors.
Funding sources: None.
Conflicts of interest: None disclosed.
IRB approval status: Reviewed and approved by Partners Human Research Committee/IRB approval #2018P000936.