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Schleder S, Jung EM, Schicho A, Schreyer AG, Habicher W, Grassinger J, Dollinger M. Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic. Clin Hemorheol Microcirc 2023; 83:397-408. [PMID: 36683499 DOI: 10.3233/ch-221680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.
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Affiliation(s)
- Stephan Schleder
- Department of Diagnostic and Interventional Radiology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas G Schreyer
- Department of Diagnostic and Interventional Radiology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Werner Habicher
- Department of Othorhinolaryngology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Jochen Grassinger
- Department of Hematology and Oncology, Merciful Brothers Hospital St. Elisabeth, Straubing, Germany
| | - Marco Dollinger
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Kroft SH, Sever CE, Bagg A, Billman B, Diefenbach C, Dorfman DM, Finn WG, Gratzinger DA, Gregg PA, Leonard JP, Smith S, Souter L, Weiss RL, Ventura CB, Cheung MC. Laboratory Workup of Lymphoma in Adults: Guideline From the American Society for Clinical Pathology and the College of American Pathologists. Arch Pathol Lab Med 2021; 145:269-290. [PMID: 33175094 DOI: 10.5858/arpa.2020-0261-sa] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery led to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. OBJECTIVE.— To develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. DESIGN.— The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, recommendations were derived based on the available evidence, strength of that evidence, and key judgements as defined in the Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision framework. RESULTS.— Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. CONCLUSIONS.— Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions on specimen suitability, diagnostic capabilities, and correct use of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.
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Affiliation(s)
- Steven H Kroft
- From the Department of Pathology, Froedtert Hospital and the Medical Colleges of Wisconsin, Milwaukee (Kroft)
| | - Cordelia E Sever
- Pathology Associates of Albuquerque, Albuquerque, New Mexico (Sever)
| | - Adam Bagg
- The Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Bagg)
| | - Brooke Billman
- Governance Services (Billman), College of American Pathologists, Northfield, Illinois
| | - Catherine Diefenbach
- The Department of Medicine, New York University School of Medicine, New York, New York (Diefenbach)
| | - David M Dorfman
- The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Dorfman)
| | - William G Finn
- The Department of Pathology and Laboratory Medicine, Warde Medical Laboratory, Ann Arbor, Michigan (Finn)
| | - Dita A Gratzinger
- The Department of Pathology, Stanford Health Care, Stanford, California (Gratzinger)
| | - Patricia A Gregg
- The Department of Pathology, Lehigh Regional Medical Center, Lehigh Acres, Florida (Gregg)
| | - John P Leonard
- The Department of Hematology and Oncology, Weill Cornell Medical College, New York, New York (Leonard)
| | - Sonali Smith
- The Department of Medicine, University of Chicago Medicine, Chicago, Illinois (Smith)
| | - Lesley Souter
- Souter is in private practice in Wellandport, Ontario, Canada
| | - Ronald L Weiss
- The Department of Pathology, ARUP Laboratories Inc, Salt Lake City, Utah (Weiss)
| | - Christina B Ventura
- The Pathology and Laboratory Quality Center (Ventura), College of American Pathologists, Northfield, Illinois
| | - Matthew C Cheung
- The Department of Medicine, Odette Cancer Centre/Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Cheung)
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3
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Kroft SH, Sever CE, Bagg A, Billman B, Diefenbach C, Dorfman DM, Finn WG, Gratzinger DA, Gregg PA, Leonard JP, Smith S, Souter L, Weiss RL, Ventura CB, Cheung MC. Laboratory Workup of Lymphoma in Adults. Am J Clin Pathol 2021; 155:12-37. [PMID: 33219376 DOI: 10.1093/ajcp/aqaa191] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The diagnostic workup of lymphoma continues to evolve rapidly as experience and discovery lead to the addition of new clinicopathologic entities and techniques to differentiate them. The optimal clinically effective, efficient, and cost-effective approach to diagnosis that is safe for patients can be elusive, in both community-based and academic practice. Studies suggest that there is variation in practice in both settings. THE AIM OF THIS REVIEW IS TO develop an evidence-based guideline for the preanalytic phase of testing, focusing on specimen requirements for the diagnostic evaluation of lymphoma. METHODS The American Society for Clinical Pathology, the College of American Pathologists, and the American Society of Hematology convened a panel of experts in the laboratory workup of lymphoma to develop evidence-based recommendations. The panel conducted a systematic review of the literature to address key questions. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, recommendations were derived based on the available evidence, the strength of that evidence, and key judgments as defined in the GRADE Evidence to Decision framework. RESULTS Thirteen guideline statements were established to optimize specimen selection, ancillary diagnostic testing, and appropriate follow-up for safe and accurate diagnosis of indolent and aggressive lymphoma. CONCLUSIONS Primary diagnosis and classification of lymphoma can be achieved with a variety of specimens. Application of the recommendations can guide decisions about specimen suitability, diagnostic capabilities, and correct utilization of ancillary testing. Disease prevalence in patient populations, availability of ancillary testing, and diagnostic goals should be incorporated into algorithms tailored to each practice environment.
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Affiliation(s)
- Steven H Kroft
- Department of Pathology, Froedtert Hospital and the Medical Colleges of Wisconsin, Milwaukee
| | | | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Brooke Billman
- Governance Services, College of American Pathologists, Northfield, IL
| | | | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - William G Finn
- Department of Pathology and Laboratory Medicine, Warde Medical Laboratory, Ann Arbor, MI
| | | | - Patricia A Gregg
- Dept of Pathology, Lehigh Regional Medical Center, Lehigh Acres, FL
| | - John P Leonard
- Department of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - Sonali Smith
- Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | | | - Ronald L Weiss
- Department of Pathology, ARUP Laboratories, Salt Lake City, UT
| | - Christina B Ventura
- Pathology and Laboratory Quality Center, College of American Pathologists, Northfield, IL
| | - Matthew C Cheung
- Department of Medicine, Odette Cancer Centre/Sunnybrook Health Sciences Centre, Toronto, Canada
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Elhamdoust E, Motamedfar A, Gharibvand MM, Jazayeri SN. Investigation of the value of ultrasound-guided core needle biopsy from pathologic lymph nodes to the diagnosis of lymphoma. J Family Med Prim Care 2020; 9:2801-2805. [PMID: 32984129 PMCID: PMC7491826 DOI: 10.4103/jfmpc.jfmpc_1260_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/06/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: In recent years, techniques with minimally invasive have been gradually developed and used in the diagnosis of lymphoma. Among minimally invasive techniques, core needle biopsy (CNB) has been widely accepted as an effective tool for the diagnosis of malignant lymphoma, carcinoma and deep tumors that are only accessible via CT or endoscopic-guided. This study was conducted to investigate of diagnostic value of ultrasound guided CNB in the diagnosis of lymphoma in all parts of the body compared to surgical excisional biopsy (SEB). Materials and Methods: This is an descriptive epidemiological study that was performed on patients with suspected lymphoma referred to the intervention ward of Golestan Hospital in Ahvaz in 2019. For all patients with suspected lymphoma, CNB of lymph nodes was performed by ultrasound-guided. Finally, the final diagnosis of CNB was compared with the results of surgical biopsy in the studied specimens. Results: In this study, 40 patients were evaluated with suspected lymphoma. At initial diagnosis with CNB, 12 (30%) had NHL, 19 (47.5%) had Hodgkin's lymphoma, and 2 had high-grade lymphoma. Of the 40 patients examined, 29 required IHC to confirm the diagnosis. In 8 cases, the final diagnosis was done using SEB. Final diagnosis in 9 (22.5%) patients was confirmed by CNB only. The CNB along with the IHC also led to the final diagnosis in 23 (57.5%) patients. However, another 8 patients required biopsy to confirm the diagnosis by SEB. Conclusion: The findings of this study indicated that US-CNB is a highly efficient method of diagnosis of lymphoma with high specificity, in the fastest possible mode and with the least complications.
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Affiliation(s)
- Elham Elhamdoust
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medicine, Ahvaz, Iran
| | - Azim Motamedfar
- Department of Radiology, Golestan Hospital, Ahvaz Jundishapur University of Medicine, Ahvaz, Iran
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Al-Abbadi MA, Barroca H, Bode-Lesniewska B, Calaminici M, Caraway NP, Chhieng DF, Cozzolino I, Ehinger M, Field AS, Geddie WR, Katz RL, Lin O, Medeiros LJ, Monaco SE, Rajwanshi A, Schmitt FC, Vielh P, Zeppa P. A Proposal for the Performance, Classification, and Reporting of Lymph Node Fine-Needle Aspiration Cytopathology: The Sydney System. Acta Cytol 2020; 64:306-322. [PMID: 32454496 DOI: 10.1159/000506497] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of lymph nodes (LN) by fine-needle aspiration cytology (FNAC) is routinely used in many institutions but it is not uniformly accepted mainly because of the lack of guidelines and a cytopathological diagnostic classification. A committee of cytopathologists has developed a system of performance, classification, and reporting for LN-FNAC. METHODS The committee members prepared a document that has circulated among them five times; the final text has been approved by all the participants. It is based on a review of the international literature and on the expertise of the members. The system integrates clinical and imaging data with cytopathological features and ancillary techniques. The project has received the endorsement and patronage of the International Academy of Cytology and the European Federation of the Cytology Societies. RESULTS Clinical, imaging, and serological data of lymphadenopathies, indications for LN-FNAC, technical procedures, and ancillary techniques are evaluated with specific recommendations. The reporting system includes two diagnostic levels. The first should provide basic diagnostic information and includes five categories: inadequate/insufficient, benign, atypical lymphoid cells of undetermined/uncertain significance, suspicious, and malignant. For each category, specific recommendations are provided. The second diagnostic level, when achievable, should produce the identification of specific benign or malignant entities and additional information by utilizing ancillary testing. CONCLUSION The authors believe that the introduction of this system for performing and reporting LN-FNAC may improve the quality of the procedure, the report, and the communication between cytopathologists and the clinicians. This system may lead to a greater acceptance and utilization of LN-FNAC and to a better interdisciplinary understanding of the results of this procedure.
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Affiliation(s)
- Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, the University of Jordan, Amman, Jordan
| | - Helena Barroca
- Serviço de Anatomia Patológica, Hospital S João-Porto, Porto, Portugal
| | | | - Maria Calaminici
- Department of Cellular Pathology, Barts Health NHS Trust and Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Nancy P Caraway
- Department of Anatomic Pathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David F Chhieng
- Department of Pathology, University of Washington Medical Center, Seattle, Washington, USA
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mats Ehinger
- Department of Clinical Sciences, Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Andrew S Field
- University of NSW Medical School, Sydney, New South Wales, Australia
- University of Notre Dame Medical School, Sydney, New South Wales, Australia
- Department of Anatomical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - William R Geddie
- University Health Network, UHN, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arvind Rajwanshi
- Department of Cytopathology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fernando C Schmitt
- Institute of Molecular Pathology and Immunology of Porto University (IPATIMUP), Instituto de Investigação e Inovação em Saúde and Medical Faculty, University of Porto, Porto, Portugal
| | | | - Pio Zeppa
- Department of Medicine and Surgery, Università degli Studi di Salerno, Fisciano, Salerno, Italy,
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6
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Lim CE, Steinfort DP, Irving LB. Diagnostic performance of 19-gauge endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in suspected lymphoma: A prospective cohort study. CLINICAL RESPIRATORY JOURNAL 2020; 14:800-805. [PMID: 32306536 DOI: 10.1111/crj.13198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 04/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) represents a minimally invasive approach in the evaluation of mediastinal/hilar lymphadenopathy. Diagnostic performance of EBUS-TBNA in lymphoma using standard 22-gauge (22G) needle is limited by sample volumes that are often inadequate for histopathological assessment. OBJECTIVES To evaluate the diagnostic utility of 19-gauge (19G) EBUS-TBNA needle in the evaluation of suspected lymphoma. METHODS We prospectively collected clinical and procedural information for patients undergoing EBUS-TBNA with 19G needle at Royal Melbourne Hospital for investigation of mediastinal/hilar lymphadenopathy, where lymphoma was considered in the differential diagnosis. All consecutive patients between June 15, 2016 and July 10, 2019 were included. If definitive diagnosis was not achieved on EBUS-TBNA, final diagnosis was determined through subsequent investigation or a minimum of 6 months radiologic surveillance. RESULTS Thirty-nine patients underwent EBUS-TBNA using 19G needle for evaluation of suspected lymphoma. Thirteen patients had a prior diagnosis of lymphoma (33%). Lymphoma was ultimately diagnosed in 23 patients (59%). Of these, 10 had a prior diagnosis of lymphoma (43%). 19G EBUS-TBNA demonstrated lymphoma in 19 patients, with a sensitivity of 83% (95% CI 66-93) for detection of lymphoma. Four patients required surgical biopsy to definitively characterise lymphoma subtype. Therefore, sensitivity of 19G EBUS-TBNA for definitive diagnosis of lymphoma was 65% (95% CI 45-81). In patients with a prior diagnosis of lymphoma, sensitivity for definitive diagnosis of lymphoma was 80% (95% CI 48-95). CONCLUSION Diagnostic performance of 19G EBUS-TBNA appears similar to standard 22G needle in detection and definitive diagnosis of lymphoma. Further invasive testing remains necessary following non-diagnostic EBUS-TBNA procedures.
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Affiliation(s)
- Christopher E Lim
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Louis B Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
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Sung S, Shirazi M, Shu CA, Crapanzano JP, Saqi A. Pulmonary small cell carcinoma: Review, common and uncommon differentials, genomics and management. Diagn Cytopathol 2020; 48:790-803. [PMID: 32348027 DOI: 10.1002/dc.24449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/20/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. It is divided into sub-categories based upon morphology, immunostaining pattern, biology, molecular profile, and/or treatment options. Up until the early 2000s when driver mutations with targeted therapies were identified in a subset of adenocarcinomas, the most critical distinction of lung carcinomas was driven by differences in treatment between small cell carcinoma (SCC) and nonsmall cell lung carcinoma (NSCLC). The distinction between SCC and NSCLC remains critical in the 21st century for management, especially for advanced stage cancer. In the vast majority of cases, morphological features are sufficient to separate SCC from other types of lung cancers. In some instances, however, cytomorphological features and immunohistochemical overlap with other tumors, limited sample availability, and/or crush artifact pose diagnostic challenges. The aim of this review is to highlight salient features of SCC and ancillary studies to distinguish it from common and uncommon potential mimickers, as well as provide updates in genomics and management.
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Affiliation(s)
- Simon Sung
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Maryam Shirazi
- Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Catherine A Shu
- Columbia University Medical Center, Department of Medicine, Hematology & Oncology, New York, New York, USA
| | - John P Crapanzano
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Anjali Saqi
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, USA
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8
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Dhanani R, Iftikhar H, Awan MS, Zahid N, Momin SNA. Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases. Int Arch Otorhinolaryngol 2020; 24:e508-e512. [PMID: 33101519 PMCID: PMC7575377 DOI: 10.1055/s-0040-1709111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/19/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.
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Affiliation(s)
- Rahim Dhanani
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Haissan Iftikhar
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Sohail Awan
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
| | - Nida Zahid
- Department of Otolaryngology/Head and Neck Surgery at the University Hospital, Aga Khan University Hospital, Karachi, Pakistan
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Cozzolino I, Vitagliano G, Caputo A, Montella M, Franco R, Ciancia G, Selleri C, Zeppa P. CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine-needle aspiration cytology samples. Diagn Cytopathol 2019; 48:211-216. [PMID: 31825183 DOI: 10.1002/dc.24366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The phenotypical identification of diagnostic cells is crucial for the diagnosis of Hodgkin's lymphoma (HL) on fine-needle aspiration cytology (FNAC). The aim of this study is to evaluate the immunocytochemical (ICC) expression of CD30, CD15, and PAX5 in Hodgkin's cells (HC) and Reed-Sternberg cells (RSC) on smears and cell-blocks (CB) of HL and to compare the performance of each antibody on smears and CB. METHODS In 21 FNAC cases of histologically confirmed classical HL, ICC identification of HC and RSC was performed using CD15, CD30, and PAX5 on smears and CB, respectively. RESULTS CD30 was positive in 19/21 cases (90.5%; 11/11 smears and 8/10 CB), CD15 was positive in 14/21 cases (66.7%; 5/11 smears and 9/10 CB), and PAX5 was positive in 13/21 cases (61.9%; 9/11 smears and 4/10CB). CONCLUSIONS CD15, CD30, and PAX5 are useful to the FNAC identification of HC and RSC. CD30 is the most sensitive, followed by CD15 and PAX5, which are more effective on CB and smears, respectively.
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Affiliation(s)
- Immacolata Cozzolino
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Vitagliano
- Department of Pathology, University of Salerno, University of Napoli "Federico II", Fisciano SA, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Marco Montella
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Department of Physical and Mental Health and Preventive Medicine School of Medicine and Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Ciancia
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Carmine Selleri
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Fisciano SA, Italy
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10
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Jelloul FZ, Navarro M, Navale P, Hagan T, Cocker RS, Das K, Rosen L, Zhang X, Sheikh-Fayyaz S. Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience. Acta Cytol 2019; 63:198-205. [PMID: 30909285 DOI: 10.1159/000497252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/26/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective is to study the efficacy of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) in the diagnosis of lymphoma in a single institution. STUDY DESIGN We retrospectively reviewed 635 FNAB/CNB cases performed in our institution to rule out lymphoma during a 4-year period and collected the relevant clinical and pathological information for statistical analysis. RESULTS AND CONCLUSIONS This cohort comprised 275 males and 360 females, with a median age of 57 years. Among the 593 cases with adequate diagnostic materials for lymphoma work-up, 226 were positive for lymphoma, 286 were negative for lymphoma, and 81 were nondiagnostic. Each case had an FNAB, and 191 cases also underwent a CNB. The subclassification rate according to the WHO (2008) was 67% overall, 81% for the FNAB with CNB group, and 40% for the FNAB group. In the FNAB with CNB group, the subclassification rates for cases with and without a history of lymphoma were not significantly different. A definitive diagnosis of lymphoma relied on ancillary studies, but was not affected by location, or the needle gauge of CNB. Follow-up data revealed a high diagnostic accuracy of FNAB with CNB. In conclusion, the use of FNAB and CNB with ancillary studies is effective in providing a definitive diagnosis of lymphoma in our experience at the Northwell Health System.
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Affiliation(s)
- Fatima-Zahra Jelloul
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Maria Navarro
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Pooja Navale
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Tamla Hagan
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Rubina S Cocker
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Lisa Rosen
- The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Xinmin Zhang
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Silvat Sheikh-Fayyaz
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA,
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11
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Yaprak Bayrak B, Kaçar Özkara S. Fine needle aspiration of non-thyroidal head and neck masses: Correlation of the cyto-histopathological diagnoses, causes of inconsistency and traps. Ann Diagn Pathol 2019; 39:15-20. [PMID: 30597402 DOI: 10.1016/j.anndiagpath.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/08/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Büşra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Sevgiye Kaçar Özkara
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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12
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Das DK. Contribution of Immunocytochemistry to the Diagnosis of Usual and Unusual Lymphoma Cases. J Cytol 2018; 35:163-169. [PMID: 30089946 PMCID: PMC6060583 DOI: 10.4103/joc.joc_42_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Some of the limitations of fine needle aspiration (FNA) in the cytodiagnosis of lymphoma include problems encountered in differentiating reactive hyperplasia from low-grade non-Hodgkin lymphoma (NHL), lower cytodiagnostic accuracy for NHL with a follicular (nodular) pattern and nodular sclerosis type of classical Hodgkin lymphoma (HL), and overlapping morphological features between T-cell-rich B-cell lymphoma (TCRBCL), anaplastic large cell lymphoma (ALCL), and HL. Immunocytochemistry may be of help in such situations. The B-cell lymphomas such as small lymphocytic lymphoma/CLL, follicular lymphoma (FL), mantle cell lymphoma (MCL), MALT lymphoma, Burkitt lymphoma (BL), and diffuse large B-cell lymphoma (DLBCL) have pan-B-cell markers (CD19, CD20, CD22, CD23, and CD79a). The FL (centrocytic), MCL, and MALT lymphoma can be differentiated with the use of a panel consisting of CD5, CD10, and CD23. In addition, FL is BCL2+ and MCL is BCL2+ as well as cyclin D1+. The DLBCL is BCL6+ in 60–90% cases. Besides pan B-cell marker, the immunocytochemical profile of BL includes CD10+, BCl6+, EBV±, and Ki67+ (100% cells). TCRBCL, a rare variant of DLBCL can be immunocytochemically differentiated from anaplastic large cell lymphoma (CD45+, CD30+, CD15‒, T±, B‒, EMA+, ALK1±) and classical HL (CD30+, CD15+, CD45‒, B‒, T‒, EMA‒). Unlike classical HL, the nodular lymphocytic predominant HL has a phenotype that includes LCA+, CD20+, CD79a+, CD15‒, and CD30‒. Whereas the immature neoplastic cells of T-lymphoblastic lymphoma (LBL) are CD3+, CD20‒, and Tdt+, the rarely encountered mature T-CLL/T-PLL are immunophenotypically CD3+, CD4+, CD5+, CD7+, CD8‒, CD20‒, CD23‒, and Tdt‒.
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Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, and Cytology Unit, Mubarak Al-Kabeer Hospital, Kuwait
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13
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Das DK, Pathan SK, Al-Waheeb SKM, Ali AE, Joneja M, Al-Kanderi MG, John B, Mallik MK. Chest wall lymphomas: Fine needle aspiration cytodiagnosis and review of the literature. Cytopathology 2017; 28:364-370. [PMID: 28730684 DOI: 10.1111/cyt.12433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Compared to other chest wall malignancies, lymphoma is a common disease. However, published literature on a series of lymphoma cases involving the chest wall is scarce. The aim of the present study, was to describe experience with chest wall swellings diagnosed as lymphoid neoplasms on fine needle aspiration (FNA) cytology. METHODS Eleven chest wall swellings were diagnosed as lymphoid neoplasms on FNA over a period of 15 years (January 2000-December 2014). The age of patients ranged from 19 to 73 years (median, 46). The male-to -emale ratio was 7:4. Ten cases had an anterior or lateral chest wall mass, and one swelling was in the scapular region. Six cases had concurrent lymphadenopathy, and one had bone involvement. The FNA smears were reviewed and classified under WHO Classification of Hematopoietic Neoplasms. The histopathological diagnoses were available in eight cases. RESULTS The preliminary cytodiagnoses in 11 cases of chest wall lymphoid neoplasms were anaplastic large cell lymphoma (ALCL) in two cases, and ALCL/malignant melanoma, ALCL/T-cell-rich-B-cell lymphoma (TCRBCL)/Hodgkin's lymphoma (HL), plasmacytoma/neuroendocrine carcinoma, Hodgkin's lymphoma, small cell NHL/CLL, NHL, suggestive of NHL, post-transplant peripheral T-cell lymphoma (PTCL), and a malignant plasma cell tumour in one case each. The reviewed cytodiagnoses of lymphoid neoplasms were as follows: ALCL ( five cases), centroblastic lymphoma (two cases), and small cell lymphoma/CLL, post-transplant peripheral T-cell lymphoma, Hodgkin's lymphoma and plasmacytoma (one case each). Histopathological diagnoses available in eight cases confirmed the presence of lymphoid neoplasms. CONCLUSION A variety of lymphoid neoplasms involved the chest wall, and among them, ALCL was a common form.
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Affiliation(s)
- D K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Al-Jabriya, Kuwait.,Cytology Unit, Mubarak Al-Kabeer Hospital, Al-Jabriya, Kuwait
| | - S K Pathan
- Cytology Unit, Mubarak Al-Kabeer Hospital, Al-Jabriya, Kuwait
| | - S K M Al-Waheeb
- Department of Pathology, Faculty of Medicine, Kuwait University, Al-Jabriya, Kuwait.,Histopathology Laboratory, Hussain Makki Al-Juma Center for Specialized Surgery, Shuwaikh, Kuwait
| | - A E Ali
- Histopathology Laboratory, Hussain Makki Al-Juma Center for Specialized Surgery, Shuwaikh, Kuwait
| | - M Joneja
- Department of Histopathology, YACO Medical's Radiology Nuclear Medicine Laboratory Center, Al-Adan Hospital, Mahboula-Fahaheel, Kuwait
| | - M G Al-Kanderi
- Cytology Unit, Mubarak Al-Kabeer Hospital, Al-Jabriya, Kuwait
| | - B John
- Department of Pathology, Faculty of Medicine, Kuwait University, Al-Jabriya, Kuwait
| | - M K Mallik
- Cytology Unit, Mubarak Al-Kabeer Hospital, Al-Jabriya, Kuwait
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14
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Das DK, Sheikh ZA, Al-Shama'a MH, John B, Alawi AMS, Junaid TA. A case of composite classical and nodular lymphocyte predominant Hodgkin lymphoma with progression to diffuse large B-cell non-Hodgkin lymphoma: Diagnostic difficulty in fine-needle aspiration cytology. Diagn Cytopathol 2016; 45:262-266. [DOI: 10.1002/dc.23643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Dilip K. Das
- Department of Pathology Faculty of Medicine; Kuwait University; Kuwait
- Cytology Unit, Mubarak Al-Kabeer Hospital; Kuwait
| | | | | | - Bency John
- Department of Pathology Faculty of Medicine; Kuwait University; Kuwait
| | | | - Thamradeen A. Junaid
- Department of Pathology Faculty of Medicine; Kuwait University; Kuwait
- Histopathology Unit, Mubarak Al-Kabeer Hospital; Kuwait
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15
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Barroca H, Marques C. A Basic Approach to Lymph Node and Flow Cytometry Fine-Needle Cytology. Acta Cytol 2016; 60:284-301. [PMID: 27639613 DOI: 10.1159/000448679] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/22/2016] [Indexed: 12/21/2022]
Abstract
According to the World Health Organization (WHO), the new classification of lymphomas is mainly based on morphological, immunophenotypical, and molecular criteria. Consequently, this new approach has led from the substantial role that architecture played in the past to a secondary panel highlighting the role of fine-needle biopsy (FNB). Applied together with other ancillary techniques, such as flow cytometry (FC), FNB is a potential tool for the diagnosis of lymphomas, and enlarged lymph nodes represent an excellent target for the implementation of this technique. Despite the difficulties inherent in this technology, which might pose problems in differential diagnosis, in the majority of cases this joint work allows an accurate diagnosis of malignancy and even correct subcharacterization in routine lymphomas. Additionally, in selected cases, other molecular techniques like FISH and PCR can also be performed on FNB specimens, helping in the characterization and diagnosis of lymphomas. In this review, we discuss the basic aspects of the combination of FNB cytology and FC in the diagnosis and subclassification of lymphomas. The preanalytical phase is extensively discussed. The advantages, disadvantages, and technical limitations of this joint work are addressed in general and in terms of the accurate subclassification of lymphomas.
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Affiliation(s)
- Helena Barroca
- Laboratório de Anatomia Patológica, Centro Hospitalar de S. João, Porto, Portugal
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16
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Iacob A, Zazgyva A, Ormenişan A, Mezei T, Sin A, Tilinca M. Effectiveness of fine-needle aspiration cytology in the diagnosis of lateral cervical nonthyroid tumors. Medicine (Baltimore) 2016; 95:e4448. [PMID: 27495074 PMCID: PMC4979828 DOI: 10.1097/md.0000000000004448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Given that the clinical and radiological examinations of lateral cervical masses are not always sufficient for deciding on appropriate management, the cytological examination of the material obtained by fine-needle aspiration might be an efficient tool in the preoperative investigation of these lesions.In this prospective cross-sectional study we evaluated the efficacy and diagnostic accuracy of fine-needle aspiration cytology in the assessment of lateral cervical nonthyroid tumors, by comparing its results with those of histopathology.A total of 58 patients with lateral cervical masses were included. Preoperative cytological results were compared with the histopathologic examination of surgical specimens.Both cytology and histology indicated that malignant tumors outnumbered benign lesions (62% vs 38%), with 88.9% of malignancies presenting in patients aged >50 years, but cytology was less effective at differentiating between benign and nontumor lesions. Cytology had 76.5% specificity and 78.1% sensitivity for identifying malignant lateral cervical lesions, and there was a concordance between the two diagnostic tests (McNemar test, P = 0.17, κ = 0.50, P <0.001).Fine-needle aspiration cytology is a simple, quick, and effective procedure that can aid in the preoperative evaluation of lateral cervical masses by differentiating benign tumors and inflammatory processes from malignancies and thus help in determining a subsequent therapeutic strategy.
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Affiliation(s)
- Alina Iacob
- Department of Oral and Maxillo-Facial Surgery
| | - Ancuta Zazgyva
- Department of Cell and Molecular Biology
- Correspondence: Ancuta Zazgyva, University of Medicine and Pharmacy Târgu-Mureş, Târgu-Mureş, Romania (e-mail: )
| | | | - Tibor Mezei
- Department of Pathology, University of Medicine and Pharmacy of Târgu-Mureş, Gh. Marinescu, Târgu-Mureş, Romania
| | - Anca Sin
- Department of Cell and Molecular Biology
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17
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Groneck L, Quaas A, Hallek M, Zander T, Weihrauch MR. Ultrasound-guided core needle biopsies for workup of lymphadenopathy and lymphoma. Eur J Haematol 2016; 97:379-86. [DOI: 10.1111/ejh.12742] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Groneck
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
| | - Alexander Quaas
- Institut für Pathologie; Universitätsklinik Köln; Köln Germany
| | - Michael Hallek
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
- Centrum für Integrierte Onkologie CIO Köln; Köln Germany
| | - Thomas Zander
- Klinik I für Innere Medizin, Hämatologie und Onkologie; Universitätsklinik Köln; Köln Germany
- Centrum für Integrierte Onkologie CIO Köln; Köln Germany
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18
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Das DK, Sheikh ZA, Alansary TA, Amir T, Al-Rabiy FN, Junaid TA. A case of Langerhans' cell histiocytosis associated with Hodgkin's lymphoma: Fine-needle aspiration cytologic and histopathological features. Diagn Cytopathol 2015; 44:128-32. [PMID: 26608102 DOI: 10.1002/dc.23392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 09/25/2015] [Accepted: 11/09/2015] [Indexed: 12/11/2022]
Abstract
Langerhans cell histiocytosis (LCH) can be associated with a variety of malignant neoplasms, the most common being malignant lymphoma, especially Hodgkin's lymphoma (HL). In this report, we describe the fine needle aspiration (FNA) cytologic features of a case with concurrent LCH and HL in a lymph node. A 20-year-old man presented with an enlarged left upper cervical lymph node. FNA smears from the swelling revealed numerous CD1a+ and S-100+ Langerhans-type cells (LCs) along with many eosinophils, neutrophils, and lymphocytes; there were also large atypical cells with enlarged nuclei having prominent nucleoli. The cytodiagnosis was LCH and the possibility of association with or trans-differentiation into a lymphoma was suggested. The histopathological diagnosis of the excised left cervical lymph node was classical HL-nodular sclerosis type (CHL-NS) with LCH. The lacunar type Reed-Sternberg (RS) cells were positive for CD30 and CD15, and the LCs were positive for CD1a and S-100 protein. PET/CT imaging demonstrated hypermetabolic lymph nodes in neck, abdomen, thorax and pelvis as well as pulmonary nodules and a splenic mass. The patient received 13 courses of chemotherapy and two years later, the enhanced CT revealed regressive course of the disease.
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Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait.,Mubarak Al-Kabeer Hospital, Cytology Unit, Jabriya, Kuwait
| | - Zafar A Sheikh
- Mubarak Al-Kabeer Hospital, Cytology Unit, Jabriya, Kuwait
| | | | - Thasneem Amir
- Hussain Makki Al-Juma Center for Specialized Surgery, Kuwait
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19
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Glaser SL, Clarke CA, Keegan THM, Chang ET, Weisenburger DD. Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice? Cancer Epidemiol Biomarkers Prev 2015; 24:1474-88. [PMID: 26215294 PMCID: PMC4592457 DOI: 10.1158/1055-9965.epi-15-0281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/20/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Histologic subtypes of classical Hodgkin lymphoma [cHL; e.g., nodular sclerosis, mixed cellularity, not otherwise specified (NOS)] are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for mixed cellularity and increases for NOS require examination. METHODS We analyzed detailed histology-specific Hodgkin lymphoma incidence rates in 1992 through 2011 U.S. SEER data (n = 21,372) and reviewed a regional subset of 2007 through 2011 NOS pathology reports for insight into diagnostic practices. RESULTS cHL rates were stable until 2007, then decreased for whites [annual percent change (APC) and 95% confidence interval (CI), -3.6% (-5.6% to -1.5%)]. Nodular sclerosis rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992 through 2011, mixed cellularity rates declined [APC -4.0% (-4.7% to -3.3%)], whereas NOS rates rose [5.3% (4.5%-6.2%)] overall and in most patient groups. The 2007-2011 NOS age-specific rates were more similar to mixed cellularity rates for 1992-1996 than 2007-2011. Trends in combined rates were minimal, supporting increasing misclassification of mixed cellularity, lymphocyte depletion, and specific nodular sclerosis subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%). CONCLUSION Recent nodular sclerosis rate declines largely represent true incidence changes. Long-term rate decreases for mixed cellularity and other less common subtypes, and increases for NOS (comprising ∼30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice. IMPACT Diminishing histologic subtyping undermines future surveillance and epidemiologic study of Hodgkin lymphoma. Guideline-based use of excisional biopsies and more coding quality control are warranted.
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Affiliation(s)
- Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Ellen T Chang
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California. Health Sciences Practice, Exponent, Inc., Menlo Park, California
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20
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21
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Caraway NP. Evolving role of FNA biopsy in diagnosing lymphoma: Past, present, and future. Cancer Cytopathol 2015; 123:389-93. [DOI: 10.1002/cncy.21551] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Nancy P. Caraway
- Section of Cytopathology; Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
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22
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Abstract
FNA is a simple, safe, and an inexpensive sampling technique that plays an important role in the evaluation of lymphadenopathy. The key to enhancing the accuracy of FNA diagnosis of lymphoma is the multi parameter approach in which the cytomorphologic features are evaluated in correlation with the results of ancillary studies and clinical context. A full understanding of the current lymphoma classification, clinical features associated with each lymphoma subtype and the impact of the diagnosis on patient management is essential in FNA diagnosis of lymphoma. It is also important to recognize the limitations of FNA in the primary diagnosis of some subtypes of lymphoma, and tissue biopsy should be recommended for a definitive diagnosis and subclassification in such cases.
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Affiliation(s)
- Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
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23
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Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology. Ann Hematol 2012; 91:1477-84. [PMID: 22592650 DOI: 10.1007/s00277-012-1476-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
Abstract
The clarification of enlarged lymph nodes is a common issue in clinical routine. By now, open surgery with complete lymph node extirpation, followed by histopathology, is considered as standard. We investigated the value of fine needle aspiration (FNA) and core needle biopsy (CNB) when supporting the conventional morphology by immunotyping. In total, 101 lymph nodes (reactive, n = 19; lymphoma, n = 46; metastatic, n = 36) were examined. CNB specimens were sufficient for unequivocal diagnosis by histopathology in 95 %. The FNA cytology allowed a correct diagnosis in 49 %. When supported by immunocytology, the success rate improved to 72 %. By accepting "suspicious of" as correct diagnosis, the ratio increased to 91 %. Additional use of flow cytometry in 46 samples minimized the "suspicious of" diagnoses and increased the proportion of unequivocal diagnoses in FNA specimens to 87 %. Flow cytometry allowed a correct subtyping in 20 of 21 B cell lymphoma but recognised only one of five Hodgkin lymphoma. All eight reactive samples were correctly diagnosed by flow cytometry. In summary, CNB allows a reliable clarification of an unclear lymphadenopathy. FNA is a powerful first diagnostic approach, especially if cytology is supported by immunocytology. The most substantial contribution of flow cytometry in FNA is the discrimination between reactive lymphadenopathy and B cell lymphoma.
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24
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Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
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25
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Das DK, Mallik MK, Dashti HAHMGH, Sathar SA, Jaragh M, Junaid TA. Kikuchi-fujimoto disease in fine-needle aspiration smears: A clinico-cytologic study of 76 cases of KFD and 684 cases of reactive hyperplasia of the lymph node. Diagn Cytopathol 2011; 41:288-95. [DOI: 10.1002/dc.21810] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 07/14/2011] [Indexed: 11/11/2022]
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26
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Das DK, Pathan SK, Mothaffer FJ, John B, Mallik MK, Sheikh ZA, Haji BE, Amir T, Francis IM. T-cell-rich B-cell lymphoma (TCRBCL): Limitations in fine-needle aspiration cytodiagnosis. Diagn Cytopathol 2011; 40:956-63. [DOI: 10.1002/dc.21683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 02/05/2011] [Indexed: 11/10/2022]
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27
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Banerjee D. Recent Advances in the Pathobiology of Hodgkin's Lymphoma: Potential Impact on Diagnostic, Predictive, and Therapeutic Strategies. Adv Hematol 2011; 2011:439456. [PMID: 21318045 PMCID: PMC3034907 DOI: 10.1155/2011/439456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/04/2010] [Accepted: 11/12/2010] [Indexed: 12/20/2022] Open
Abstract
From its first description by Thomas Hodgkin in 1832, Hodgkin's disease, now called Hodgkin's lymphoma, has continued to be a fascinating neoplasm even to this day. In this review, historical aspects, epidemiology, diagnosis, tumor biology, new observations related to host-microenvironment interactions, gene copy number variation, and gene expression profiling in this complex neoplasm are described, with an exploration of chemoresistance mechanisms and potential novel therapies for refractory disease.
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Affiliation(s)
- Diponkar Banerjee
- Centre for Translational and Applied Genomics (CTAG), Department of Pathology, British Columbia Cancer Agency (BCCA), 600 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E6
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 2B5
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28
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Haam SJ, Paik HC, Lee DY, Kim KW, Choi HY, Yu W. Clinical Features and Treatment of Cervical Tuberculous Lymphadenitis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seok Jin Haam
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Hyo-Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Doo-Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Kwan-wook Kim
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Hyung-yoon Choi
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Woosik Yu
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
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29
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Abstract
Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck area. They are classically divided into two subgroups, Hodgkin's lymphomas (HLs) and non-Hodgkin's lymphomas (NHLs). We describe the clinical characteristics of head and neck lymphomas and the methods to establish the diagnosis. The World Health Organization classification of lymphoid tissues describes more than 50 different histological types, and we analyse the most common staging system for lymphomas, the Ann Arbor staging system. Finally, the different therapeutic approaches are discussed.
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Affiliation(s)
- E Zapater
- ENT Department, University General Hospital, Valencia Medical School, Valencia, Spain.
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30
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Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for the Evaluation of Suspected Lymphoma. J Thorac Oncol 2010; 5:804-9. [DOI: 10.1097/jto.0b013e3181d873be] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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New developments in the pathology of malignant lymphoma: a review of the literature published from January to August 2009. J Hematop 2009; 2:171-83. [PMID: 20309425 PMCID: PMC2766446 DOI: 10.1007/s12308-009-0046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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