Accuracy of diagnosis of malignant lymphoma by combining fine‐needle aspiration cytomorphology with immunocytochemistry and in selected cases, southern blotting of aspirated cells: A tissue‐controlled study of 86 patients

Abstract

Fine-needle aspiration (FNA) cytology of lymph nodes in malignant lymphoma is fraught with difficulty. In certain clinical situations, cytology has been documented to be useful in patients with malignant lymphoma. The intent of our investigation was to determine the accuracy of a multiparameter approach in diagnosing lymphoma. We reviewed the results of FNA cytology combined with the immunocytochemistry and, in some cases, the Southern blots of aspirated cell suspensions obtained from 86 suspected lymphoma patients who subsequently underwent surgical biopsy of the aspirated site. In four cases, in which FNA was unable to retrieve sufficient material for diagnosis, the histology showed extensive fibrosis. When the FNA diagnoses were compared with the histologic diagnoses, the diagnosis concurred in 69 cases (56 malignant lymphomas, 12 reactive, 1 atypical lymphoid proliferation). There was one false-positive, six false-negatives, and eight cases diagnosed as atypical lymphoid proliferation. Overall accuracy was 91%. There were two types of false-negative cases: those in which a diagnosis of another malignancy or unspecified malignant neoplasm was made and those that were diagnosed as reactive when the histology showed lymphoma. In seven cases, the DNA rearrangement studies of the antigen receptor genes were successfully performed on the aspirated cells and were useful in establishing lineage and clonality of both B and T lymphoid cells. Our study indicated that the use of a multiparameter approach in the diagnosis of malignant lymphoma by FNA enhanced the accuracy of diagnosis of the non-Hodgkin's lymphomas. In Hodgkin's disease, no benefit was derived from the approach.

Cytodiagnosis of Lymphoid Proliferations by Fine Needle Aspiration Biopsy

“…2,3,5,10,11,23 There is considerable morphologic overlap between benign and malignant conditions. 5,8,18,30,32 Inability to assess architectural patterns and the absence of a phenotype precludes subclassification.…”

Fine Needle Aspiration Cytology and Flow Cytometry in the Diagnosis and Subclassification of Non-Hodgkin’s Lymphoma Based on the World Health Organization Classification

“…In 8 patients (14-21) the incorrect diagnosis of lymphoma was made. Three cases (22)(23)(24) were considered to be malignant lymphoma by cytomorphology. However, these 3 cases were reactive lymphoid hyperplasia, confirmed by biopsy in 2 cases and follow-up examination in the remaining case.…”

Role of endoscopic ultrasonography with and without fine needle aspiration cytology in the diagnosis and staging of lymphoma

“…Regarding EUS-FNA, karyotyping has been rarely performed [32,38,47] . In the largest series [55] , 240 patients with suspected lymphoma were included.…”

“…In the studies using a percutaneous approach, sensitivity and diagnostic accuracy ranged from 66%-90% and 80%-60% respectively [45][46][47] . FC may also be helpful in the immunological sub-typing of nodal lymphoma.…”