Real-world outcomes of endoscopic ultrasound–guided tissue acquisition for actionable diagnosis in suspected primary or recurrent lymphoma

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BACKGROUND AND AIMS: Although excisional biopsy is the reference standard for diagnosing lymphoma, EUS-guided biopsy offers a less-invasive alternative. However, its utility in both newly suspected and recurrent lymphomas remains limited. METHODS: We retrospectively reviewed 87 consecutive patients who underwent EUS-guided tissue acquisition for suspected lymphoma (46 primary and 41 recurrent cases). An actionable diagnosis was defined as confirmed lymphoma with definitive subtyping or exclusion of lymphoma by alternative pathology or ≥12 months of disease-free follow-up. Technical success, safety, diagnostic outcomes, and longitudinal trends were analyzed. RESULTS: Technical success was achieved in 98.9% of patients, with minor adverse events in 3.4%. An actionable diagnosis was made in 74 patients (85.1%), including 38 of 46 with primary suspicion (82.6%) and 36 of 41 with suspected recurrence (87.8%). Among the recurrent cases-most of which were previously diagnosed by excisional or percutaneous biopsy-EUS fine-needle biopsy confirmed the subtype in 25 patients (61.0%) and excluded lymphoma in 11 (26.8%), yielding a negative predictive value of 90.9%. No clinical or procedural predictors of actionable diagnosis were identified. Eventually, indications increasingly shifted toward recurrence (annual increase 1.82-fold; 95% CI, 1.46-2.38; P < .001), paralleled by greater use of the 22-gauge Acquire (Boston Scientific, Marlborough, Mass, USA) needle. CONCLUSIONS: EUS-guided biopsy is safe and yields accurate results in most patients with suspected lymphoma. In clinical practice, the use of EUS-guided biopsy for suspected recurrent lymphoma with a confirmed biopsy is increasing. These findings support its expanding role as a minimally invasive alternative diagnosis method.

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