Flow-cytometric algorithm on fine-needle aspirates for the clinical workup of patients with lymphadenopathy

Diagnosis of hematopoietic processes by fine-needle aspiration in conjunction with flow cytometry: A review of 127 cases

Although fine-needle aspiration (FNA) is accepted as the method of choice for the initial evaluation of lymph nodes for metastatic carcinomas, its utility as the initial diagnostic procedure for hematopoietic processes is less established. We review our experience over a 3-year period with 127 FNA cases accompanied by flow cytometric (FC) analysis from 117 patients. Fifty cases had subsequent histologic examination. A hematopoietic process was identified in 85 cases, a reactive process in 27 cases, and a nonhematopoietic process in 15 cases. All non-Hodgkin lymphomas (NHL) were B-cell processes except for one T-cell lymphoma. By FNA/FC, 44 NHL had sufficient findings to be subtyped; of these, 27 had subsequent histologic examination. The correlation between the FNA/FC and histologic classification in these cases of NHL was 100%. One case was insufficient for diagnosis by FNA and six cases were inadequate for FC. We conclude that FNA in conjunction with FC can be used as the initial diagnostic approach for both primary and recurrent hematopoietic processes.

Diagnosis of peripheral T-cell lymphoma by fine-needle aspiration biopsy: a cytomorphologic and immunophenotypic approach

The diagnosis of T-cell lymphomas by fine-needle aspiration biopsies (FNAB) is extremely difficult. This is mainly due to the rarity of the disease, the morphologic similarity to reactive lymphadenopathy, and the difficulty in identifying abnormal T-cell antigen expression. We studied FNAB of histologically proven T-cell lymphomas in an attempt to identify the salient cytomorphologic features as well as the surface marker attributes of the disease. Twenty cases were reviewed. The smears were evaluated for overall cytologic pattern and percentage of abnormal cells. A critical review of flow cytometric (FCM) antigen expression of the lymphomas was also performed. There were 6 female and 14 male patients, with an age range of 9-84 yr (median, 36 yr). Fourteen cases (70%) showed polymorphous smears, and 6 cases (30%) showed monomorphous smears. Abnormal cells ranged from 10-100% (median, 60%). Abnormal T-cell antigen expression by FCM analysis was seen in 17 cases (85%). The most common aberrant T-cell antigen pattern was loss of 3 or more pan-T-cell antigens (n = 10). The most common individual T-cell antigen loss was that of CD7 (n = 10), followed by loss of CD5 (n = 5). There was also loss of CD4 and CD8 (n = 5), loss of CD5 and CD7 (n = 5), complete loss of CD3 (n = 4), coexpression of CD4 and CD8 (n = 1), and partial loss of CD3 (n = 1). CD56 was expressed in 2 cases. CD1a was tested in one case and was positive. CD4/CD8 ratio was elevated (>2.5) in 9 cases (53%), with a range of 3/1-57/1 (median, 12/1). TCR gene rearrangement using PCR was positive in 7 of 9 tested cases. Our findings suggest that the diagnosis of peripheral T-cell lymphomas can be achieved by FNAB in the majority of cases through close analysis of the morphology. This can be supported by a critical analysis of the phenotype using two or three-color flow cytometry with an attempt at identification of one or more abnormal T-cell antigen expression and/or loss. This can be supplemented by CD4/CD8 ratios and T-cell receptor gene rearrangement analysis.

Immunoflow cytometry and cell block immunohistochemistry in the FNA diagnosis of lymphoma: a review of 73 consecutive cases

AIMS

To review the results of 73 consecutive fine needle aspirations (FNAs) that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions.

METHODS

The setting was a large general hospital in rural New Zealand. The FNAs were performed by a pathologist, or a radiologist for image guided localisations. Material for immunoflow cytometry was collected into RPMI and, when required, material for a cell block was collected into formalin.

RESULTS

Of the 73 samples collected by FNA nine were inadequate. Light chain restriction could be demonstrated in most FNA samples from B cell lymphomas (28 of 30 adequate samples). The exceptions were two cases of T cell rich B cell lymphoma. Artefactual light chain restriction was seen occasionally in T cell lymphomas, presumably as a result of autoantibodies binding to the cell surfaces. It was possible to subtype most (18 of 30 adequate samples) B cell lymphomas as chronic lymphocytic leukaemia (CLL), follicle centre cell lymphoma (FCCL), or mantle cell lymphoma. The CD4 to CD8 ratio was not usually restricted in T cell lymphomas and coexpression of CD4 and CD8 was not usually found. Loss of pan-T cell antigens was seen in some T cell lymphomas. Four of the six T cell lymphomas and three of the four non-lymphoid malignacies were diagnosed with the aid of cell block immunohistochemistry. Only one of the four cases of Hodgkin's lymphoma showed Reed-Sternberg cells in the FNA smears.

CONCLUSIONS

It is not always possible to characterise lymphomas as fully with FNA and immunoflow cytometry as is possible with biopsy histology and a full battery of modern investigations. Nevertheless, in the setting of a large rural general hospital immunoflow cytometry on FNA samples is a highly effective method of diagnosing and typing B cell lymphomas. Immunoflow cytometry is of little use for T cell lymphomas or Hodgkin's lymphomas. We advocate the use of cell block immunohistochemistry in preference to immunoflow cytometry for cases in which the cytological appearance of the specimen is overtly malignant but the differential diagnosis includes non-lymphoid malignancy.

Fine-needle aspiration cytology of lymphoproliferative lesions involving the major salivary glands

Fine-needle aspiration biopsy (FNA) is an accurate and cost-effective procedure for evaluating salivary gland lesions. Lymphoproliferative lesions may manifest as salivary gland enlargement. We report our experience with 43 cases of reactive and neoplastic lymphoproliferative lesions of the salivary glands evaluated by FNA, including 23 cases of reactive lymphoid hyperplasia and 20 neoplastic lymphoproliferative processes. The latter included 2 multiple myelomas and 18 non-Hodgkin lymphomas (small lymphocytic lymphoma/chronic lymphocytic leukemia, 1; small cleaved cell lymphoma, 1; lympho-plasmacytoid lymphoma, 1; mucosa-associated lymphoid tissue lymphoma, 2; mixed cell lymphoma, 4; lymphoblastic lymphoma, 1; and large cell lymphoma, 8). There were no false-negative diagnoses. Aspiration smears from 3 patients with reactive lymphoid hyperplasia and 4 patients with malignant lymphoma initially were interpreted as atypical lymphoid proliferations or as suggestive of malignant lymphoma. Thus, FNA had a sensitivity of 100% and a specificity of 87%. The majority of patients were treated medically without surgical intervention. Among the patients who underwent surgical resection of the salivary gland, 7 had an equivocal cytologic diagnosis and 2 had a benign cytologic diagnosis, but their parotid swelling failed to regress despite medical treatment. In most instances, FNA provides useful information for subsequent disease management and obviates surgical intervention.