Flow cytometric detection of B‐clonal excess in fine needle aspirates for enhanced diagnostic accuracy in non‐Hodgkin's lymphoma in adults

Abstract

Fine needle aspiration (FNA) cytology is a valuable aid to diagnosis and tumour staging in patients with non-Hodgkin's lymphoma. These tumours are often multicentric and involve sites such as the liver or the spleen which are not easily accessible to surgical biopsy. Particularly with splenic involvement, there is a diagnostic problem of morphologically distinguishing the lymphoma cells in an admixture of normal lymphocytes. Since most lymphomas in adults are of B-cell origin, we studied the diagnostic value of adding a surface immunoglobulin (sIg) light chain analysis to the cytological evaluation of FNAs. B-clonal excess was determined by flow cytometric analysis of the sIg light chain distribution and a monoclonal finding was considered diagnostic of lymphoma. In primary diagnostic procedures the light chain analysis established a diagnosis of lymphoma in 5/14 (36%) aspirates from patients with poorly differentiated tumours. Fine needle aspirates performed as part of staging procedures were morphologically normal or inconclusive in 19 cases; in seven of these (37%) lymphoma involvement was diagnosed by the light chain analysis. Diagnostic precision was enhanced by combining morphological and immunological evaluation of fine needles aspirates in patients with established or suspected non-Hodgkin's lymphoma.

Splenic Fine Needle Aspiration and Core Biopsy

“…20 In another study, 37% of cases with normal or inconclusive findings on sFNA were diagnosed as ML by light chain analysis. 16 In our study the usefulness of ancillary techniques was demonstrated by confirmation of the diagnosis of ML by FC in 2 patients and by IHC in 3. It has been suggested that sFNA is useful for patients with splenic masses as compared to splenomegaly.…”

“…2,4,9-11 Lymphoma has also been evaluated in some studies by this procedure. 15,16 However, there are very few reports on the use of sFNA for metastatic lesions of the spleen owing to the relative infrequency of these lesions 17 and fear of hemorrhagic complications. 18 Our analysis suggests that sFNA and sCB have good diagnostic accuracy, are fairly safe and can obviate the need for an open biopsy or splenectomy in the majority of the cases.…”

Percutaneous Image-guided Biopsy of the Spleen: Systematic Review and Meta-Analysis of the Complication Rate and Diagnostic Accuracy

“…Several more recent publications have reported much lower complication rates with smaller needle diameters (18 gauge or smaller) ( 5,6,16 ). Diseases that commonly affect the spleen can pose a diagnostic challenge to the clinician, radiologist, and pathologist, and the reported diagnostic accuracy of splenic biopsy varies, ranging between 84% and 90% ( 5,14,(16)(17)(18)(19)(20)(21).…”

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

“…[28][29][30][31][32][33][34][35][36][37][38][39] The majority of the studies used the Working Formulation Classification of NHL. However, comparison of the studies was very difficult because classification was often in generic terms such as small cell NHL or large cell NHL.…”