Original article
Skin biopsy in the diagnosis of intravascular lymphoma: A retrospective diagnostic accuracy study

https://doi.org/10.1016/j.jaad.2019.09.015Get rights and content

Background

The yield of skin biopsies in the evaluation of intravascular lymphoma (IVL) is largely unknown in Western patients. Most data supporting this test come from Asian populations, in which both prevalence and disease presentation seem to differ.

Objective

To determine the yield and diagnostic properties of skin biopsy in the evaluation of IVL.

Methods

We reviewed skin biopsy pathology reports of 50 patients being evaluated for IVL to calculate the diagnostic yield of this test. An additional 6 patients, who underwent skin biopsies after the diagnosis of IVL was made by other means, were included to calculate the sensitivity and specificity of our index test.

Results

Skin biopsy samples were positive for 5 of the 50 patients being investigated for IVL. Sensitivity was 50% and specificity was 100%.

Limitations

Only pathology reports containing IVL as an indication for the biopsy were retrieved. This might have excluded patients in whom the disease was considered but was not deemed likely enough to be listed as the indication for the test, inflating our estimative of skin biopsy yield.

Conclusion

A relatively high diagnostic yield was found in the evaluation of IVL among patients with a diverse presentation in a Western hospital.

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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    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.

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