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<p>Random skin biopsy (RSB) remains an important tool for diagnosing intravascular large B-cell lymphoma (IVLBCL), with prior studies favoring inclusion of cherry angiomas and an incisional approach. However, these data are primarily derived from case reports and Asian patient populations. Optimal biopsy techniques in Western cohorts remain undefined. We conducted a retrospective cross-sectional study (2019–2024) at Johns Hopkins Hospital, evaluating inpatients who underwent skin biopsy for suspected IVLBCL. A systematic scoping review was performed to assess punch RSB use for IVLBCL diagnosis in Western populations. Fifty-nine patients (median age, 66 years; 56% male; 70% non-Hispanic White) underwent 163 punch biopsies. IVLBCL was diagnosed in 11 patients; 9 via skin biopsy and 2 via brain biopsy. Sensitivity of punch RSB was 71.4% per biopsy and 81.8% per patient. Specificity was 100%. RSBs from normal skin had higher sensitivity than those from cherry angiomas (87.5% vs. 65.0%; <i>p</i>&lt;0.01). Among positive biopsies, 37% lacked any fat involvement, while 11% (<i>n</i> = 2) were confined to the deep subcutis only. The systematic review identified 3 eligible studies and, among 22 patients diagnosed with IVLBCL, the pooled punch RSB sensitivity was 22.2%. In conclusion, this single-center review consisting of the largest Western IVLBCL cohort reported to date revealed that the sensitivity of punch RSB was comparable to that of incisional RSB reported in Asian populations and exceeded pooled estimates from our systematic review of Western cohort studies. Cherry angioma biopsies did not increase diagnostic yield in our cohort, though IVLBCL phenotype and/or severity may influence its sensitivity. In the absence of skin lesions we recommend performing ≥ 4-mm punch RSBs from ≥ 3 fat-rich sites, favoring the proximal extremities.</p>

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Random punch skin biopsies demonstrate sensitivity comparable to incisional biopsies for detecting intravascular large B-cell lymphoma: a cross-sectional U.S. cohort study and systematic review

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Saloni Patel,
  • Jeffrey Weiner,
  • Keon Niknejad,
  • Charles Lu,
  • Jaroslaw J. Jedrych,
  • Sima Rozati,
  • Jun Kang

摘要

Random skin biopsy (RSB) remains an important tool for diagnosing intravascular large B-cell lymphoma (IVLBCL), with prior studies favoring inclusion of cherry angiomas and an incisional approach. However, these data are primarily derived from case reports and Asian patient populations. Optimal biopsy techniques in Western cohorts remain undefined. We conducted a retrospective cross-sectional study (2019–2024) at Johns Hopkins Hospital, evaluating inpatients who underwent skin biopsy for suspected IVLBCL. A systematic scoping review was performed to assess punch RSB use for IVLBCL diagnosis in Western populations. Fifty-nine patients (median age, 66 years; 56% male; 70% non-Hispanic White) underwent 163 punch biopsies. IVLBCL was diagnosed in 11 patients; 9 via skin biopsy and 2 via brain biopsy. Sensitivity of punch RSB was 71.4% per biopsy and 81.8% per patient. Specificity was 100%. RSBs from normal skin had higher sensitivity than those from cherry angiomas (87.5% vs. 65.0%; p<0.01). Among positive biopsies, 37% lacked any fat involvement, while 11% (n = 2) were confined to the deep subcutis only. The systematic review identified 3 eligible studies and, among 22 patients diagnosed with IVLBCL, the pooled punch RSB sensitivity was 22.2%. In conclusion, this single-center review consisting of the largest Western IVLBCL cohort reported to date revealed that the sensitivity of punch RSB was comparable to that of incisional RSB reported in Asian populations and exceeded pooled estimates from our systematic review of Western cohort studies. Cherry angioma biopsies did not increase diagnostic yield in our cohort, though IVLBCL phenotype and/or severity may influence its sensitivity. In the absence of skin lesions we recommend performing ≥ 4-mm punch RSBs from ≥ 3 fat-rich sites, favoring the proximal extremities.