Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification—Re-evaluation of cases from 1999–2004 with new proposals

Abstract

With the advent of modern therapy, the differences in prognoses and treatment regimens among different subtypes of Hodgkin lymphoma (HL) have largely vanished. Stage and the presence of systemic symptoms are much more important than histologic subtypes as predictive factors. The current (2001) WHO classification markedly de-emphasizes spatial relationships as critical to the diagnosis of lymphoma and emphasizes cell morphology, immunophenotype, genetic features, and clinical information to define the disease states. This classification, thus, greatly enhances the capability of fine-needle aspiration (FNA) to accurately diagnose HL. We searched all the FNA cases in our institute in years 1999 through 2004 and found 42 cases, for which 13 were primarily diagnosed (31.0%), 2 were recurrent (4.8%), 5 were highly suspicious (11.9%), and 22 were suspicious (52.3%) for HL. On follow-up tissue biopsy, all the primarily diagnosed, recurrent, and highly suspicious cases were confirmed to be HL (100% agreement). For the 22 suspicious cases, 13 were HL (59.1%), 5 were other lymphomas (22.8%), 1 was lymphoma unclassifiable (4.5%), and 3 were reactive processes (13.6%). The effect of immunostains on the diagnosis of HL was examined, and its importance was emphasized. Analysis of demographic data and the distribution of HL subtypes demonstrate that the study sample is representative of the general HL patient population. On the basis of these results, we propose: (1) If the FNA diagnosis of HL is confirmed both by morphology and immunostains, no further tissue confirmation, subclassification and grading is necessary, and appropriate treatment regimens should follow. (2) The nodular lymphocyte predominant HL and classical HL can be differentiated by adequate immunostaining. (3) If a definitive diagnosis cannot be achieved by FNA, a second FNA or a tissue biopsy should be recommended.

Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy

“…However, if the diagnosis of Hodgkin lymphoma had already been established, the findings of these cells were sufficient to make a diagnosis. However, Zhang et al [36] concluded that classic binucleated or multinucleated R-S cells were infrequent in many cases and the clue to the diagnosis of Hodgkin lymphoma in such situation was the frequently encountered atypical mononuclear R-S cell variant with prominent macronucleoli and granuloma together.…”

Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

“…As a diagnostic procedure, FNA is very attractive because no sedation is required. A recent study reported several new immune stains to enhance diagnostic accuracy that may limit the need for a tissue biopsy [14]. Modern immunostaining techniques were used on the FNA sample; and the diagnosis, subclassification, and grading studies were performed.…”

Recent Advances in the Pathobiology of Hodgkin's Lymphoma: Potential Impact on Diagnostic, Predictive, and Therapeutic Strategies

“…Most of these are based on small retrospective series of cases and may suffer from selection bias. FNA diagnosis of HL lesions may be associated with a false negative rate of 15–40% [52, 66, 69]. Generally, because of diagnostic errors that may occur even with the best histologic preparations, FNA samples are not considered reliable enough for the diagnosis and classification of HL.…”