Lymph Node Fine-Needle Cytology of Non-Hodgkin Lymphoma: Diagnosis and Classification by Flow Cytometry

Abstract

In the last decades, lymph node fine-needle cytology (FNC), coupled with flow cytometry (FC), has gained a role in the diagnosis and classification of non-Hodgkin lymphoma (NHL). The combination of FNC/FC allows the diagnosis and classification of NHL in lymph node samples with a high sensitivity and specificity by combining cytological features and specific phenotypic profiles. The present review provides a brief technical description of FC and a detailed analysis of the current markers and their combinations (diagnostic algorithm) for the diagnosis and classification of NHL. The basic principles of clonality assessment, as well as the diagnostic strengths and weaknesses of the procedure, are reported. The current diagnostic algorithms for NHL classification are critically reviewed with a focus on specific problems related to single entities. Moreover, this review provides a detailed analysis of the different clinical contexts in which FNC/FC is performed and related implications. Future and further applications of FNC/FC for NHL are also discussed.

Diagnostic role of cytology in serous effusions of patients with hematologic malignancies

“…We provide evidence that the diagnostic accuracy of cytology with the adjunct of immunocytochemistry is high when compared to FC for detecting hematologic malignancies. Simultaneously, we emphasize the value of FC method and the need for a multiparametric approach of lymphoproliferative disorders in serous fluids, as it has already been reported for lymph node FNA . Our clinical suggestion is to implement cytology triage for serous effusions suspected for hematologic malignancy in order to select cases for FC.…”

“…The group of patients with previous history of hematologic disease, included 5 false negative diagnoses, all occurring in the setting of a B‐cell lymphoma. Four of them were low grade lymphomas with equivocal morphology and another case in which FC detected a minor neoplastic population.…”

“…Simultaneously, we emphasize the value of FC method and the need for a multiparametric approach of lymphoproliferative disorders in serous fluids, as it has already been reported for lymph node FNA. 29,43 Our clinical suggestion is to implement cytology triage for serous effusions suspected for hematologic malignancy 8 in order to select cases for FC.…”

Cervical lymph node metastasis of ovarian dysgerminoma: A case report with fine needle aspiration cytology

“…There are several potential diagnoses when large, round cells are identified in the lymph nodes, including lymphoma, metastasis of melanoma, choriocarcinoma, or carcinoma. Lymphoma is generally characterized by single medium to large cells, irregular nuclei, and high cellularity . Cytologically, melanoma cells have inclusion‐like prominent nucleoli, and usually melanin pigments are seen .…”

‘Six Memos' for Lymph Node Fine-Needle Cytology and Flow Cytometry

“…FNC diagnosis and classification of non-Hodgkin lymphoma (NHL), which was once considered impossible, is now an acknowledged diagnostic possibility, despite its limitations. The article by Cozzolino et al [8] provides a description and a critical evaluation of the diagnostic algorithms for FNC-FC diagnosis and classification of NHL, as they have been developed in different experiences. One of the main features of NHL is the involvement of extranodal sites, either as primary or secondary processes.…”