Patients with diffuse large B cell lymphoma (DLBCL) who receive core needle biopsy are more likely to have poor-risk disease features, according to a new study published in the journal Blood Advances.

These patients are also more likely to have inadequate tissue for molecular analyses. Therefore, increasing the tissue requirements of biomarker-focused clinical trials may exclude patients who are high-risk and who may need new agents even more.

It is unknown whether core needle biopsy is sufficient to obtain enough tissue samples for clinical trials evaluating novel agents that can be specific to different subtypes of DLBCL. It is important to know the answer to this question; otherwise, only patients eligible for excisional biopsy may be enrolled in these clinical trials. 

Here, a team of researchers led by Grzegorz S. Nowakowski, MD, from the Division of Hematology, Department of Medicine at the Mayo Clinic in Rochester, Minnesota, conducted an observational study to assess the adequacy, outcomes, and characteristics of diagnostic tissues in patients with newly diagnosed DLBCL and primary mediastinal large B cell lymphoma. Patients had undergone either excisional or core needle biopsy.

Read more about the diagnosis of DLBCL

The researchers found that a significantly higher proportion of patients who have undergone core needle biopsy had advanced disease and inadequate tissue for molecular analysis. They also had significantly worse 5-year event-free and overall survival.

The researchers concluded that these patients have poor risk characteristics, inferior outcomes on frontline chemoimmunotherapy, and are more likely to have insufficient tissue for molecular analyses. They might also not meet the tissue requirements necessary for biomarker-driven clinical trials, the authors said.

They wrote, “the need for tissue should be carefully balanced against resulting selection bias.” They added that these findings should be validated in an independent cohort of patients.


Desai SH, Mwangi R, Ng WL, et al. Increasing tissue requirements in lymphoma trials may exclude patients with high risk disease or worse prognosis. Blood Adv. 2022;28:bloodadvances.2022007569. doi:10.1182/bloodadvances.2022007569