A utilidade da citologia por punção com agulha fina aliada a imunofenotipagem no diagnóstico dos linfomas não-Hodgkin Diagnosis of non-Hodgkin's lymphoma combining immunophenotyping and fine needle aspiration A classificação para linfomas não-Hodgkin (LNH) proposta pela Organização Mundial da Saúde (OMS) enfatiza a importância do imunofenótipo para o diagnóstico. O objetivo deste estudo foi avaliar a utilidade da citologia combinada a citometria de fluxo para o diagnóstico de LNH, utilizando um painel de anticorpos monoclonais e estudo do ciclo celular. O material foi obtido através de aspiração de linfonodos por agulha fina de 78 pacientes. O painel de anticorpos monoclonais para análise em citometria de fluxo foi o seguinte: CD19/CD10, CD20/CD5, CD23, CD38/CD7, CD3/CD4, CD3/ CD8, kappa/lambda. O diagnóstico final foi confirmado pela histologia convencional, considerada gold standard. Em 85% dos casos a citologia associada a imunofenotipagem e porcentagem de células em fase S permitiram um diagnóstico correto. Nos demais casos foi possível diferenciar linfomas B ou T e estimar grau de agressividade. O painel, embora pequeno, foi suficiente exceto para os anaplásicos e subclassificação dos linfomas T. Nestes casos, a morfologia foi mais importante que imunofenótipo, sendo este seguro apenas para linfomas linfoblásticos. A fração de fase S mostrou-se importante para diferenciar linfomas indolentes e de alto grau. Concluímos que esta técnica é uma boa alternativa para o diagnóstico de linfomas não-Hodgkin.
In malignant lymphomas, cell kinetics has shown to be related with histologic type as well as with the clinical behaviour. The aim of our study was to investigate the relevance of cell proliferation parameters on overall survival in non‐Hodgkin's lymphomas as well as their relationship with prognostic factors such as International Prognostic Index (IPI). We performed DNA‐flow‐cytometry (S‐phase fraction and detection of DNA‐aneuploidy) as well as cytologic examination and the AgNOR technique in material obtained by fine needle aspiration of lymph nodes at diagnosis. The majority of the patients were stage IV by Ann Arbor and intermediate risk by IPI (42/55). When analyzing all patients together, histologic type by the WHO classification, IPI and the presence of a DNA‐aneuploid clone could not separate well patients with a different survival. For all patients, univariate Cox analysis revealed S‐phase (SPF) and AgNOR parameters to be of prognostic value. In the multivariate analysis, however, only SPF remained in the final model. Yet, when stratifying for DNA‐ploidy, only the total number of AgNORs/nucleus was an independent parameter. Looking only at the DNA‐diploid cases, the AgNOR pattern remained the most important parameter, whereas for the DNA‐aneuploid cases this was true for SPF. When studying patients with B large cell lymphoma separately, only DNA‐ploidy was a prognostic factor. In summary, cell kinetic parameters reveal important prognostic information in NHL patients. Furthermore, DNA‐aneuploidy seems to interfere with the analysis of the AgNOR pattern.
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