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Ehinger M, Béné MC. Morphology and multiparameter flow cytometry combined for integrated lymphoma diagnosis on small volume samples: possibilities and limitations. Virchows Arch 2024:10.1007/s00428-024-03819-3. [PMID: 38805049 DOI: 10.1007/s00428-024-03819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.
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Affiliation(s)
- Mats Ehinger
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
| | - Marie C Béné
- Faculty of Medicine, Nantes University, Nantes, France
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Core Needle Biopsy in Lymphoma Diagnosis: The Diagnostic Performance and the Role of the Multidisciplinary Approach in the Optimization of Results. Am J Surg Pathol 2023; 47:111-123. [PMID: 36395467 DOI: 10.1097/pas.0000000000001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To compare the diagnostic accuracy of core needle biopsies (CNBs) and surgical excisional biopsies (SEBs), samples of lymphoid proliferation from a single institution from 2013 to 2017 (N=476) were divided into groups of CNB (N=218) and SEB (N=258). The diagnostic accuracy of these samples was evaluated as a percentage of conclusive diagnosis, according to the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues . The contribution of clinical data, the assessment of sample adequacy by a pathologist during the procedure, the number and size of fragments, the needle gauge, the ancillary tests, and the type of lymphoid proliferation were also examined. The diagnostic accuracy of SEB was 97.3% and CNB 91.3% ( P =0.010). Additional factors considered essential for establishing the final diagnosis in some cases were: clinical information (20.6% CNB, 7.4% SEB; P <0.001); immunohistochemistry (96.3% CNB, 91.5% SEB; P =0.024); flow cytometry (12% CNB, 6.8% SEB; P =0.165); and other complementary tests (8.2% CNB, 17.3% SEB; P =0.058). Factors that did not influence performance were the evaluation of sample adequacy during the procedure, the number and size of fragments, and the needle gauge. Increased percentage of nondiagnostic CNB was observed in T-cell lymphomas (30%), followed by classic Hodgkin lymphoma (10.6%). The main limitation of CNB was the evaluation of morphologically heterogenous diseases. CNB is useful and safe in lymphoma diagnosis provided it is carried out by a team of experienced professionals. Having an interventional radiology team engaged with pathology is an essential component to achieve adequate rates of specific diagnoses in CNB specimens.
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Acanfora G, Iaccarino A, Dello Iacovo F, Pisapia P, De Luca C, Giordano C, Bellevicine C, Picardi M, Troncone G, Vigliar E. A roadmap for a comprehensive diagnostic approach to fine needle cytology of lymph node metastases. Cytopathology 2022; 33:668-677. [PMID: 35986701 PMCID: PMC9826057 DOI: 10.1111/cyt.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Fine needle cytology (FNC) is widely used as a first-line procedure in the diagnostic algorithm of lymphadenopathies. In a metastatic setting, a first-line diagnostic approach identifies non-haematopoietic malignancy; however, cytopathologists could also provide a second diagnostic level, identifying the origin of the primary tumour. This paper outlines a comprehensive and practical approach to the cytological diagnosis of lymph node metastases. METHODS Cytological diagnoses of lymph node metastases performed over a 10-year period were selected and divided into two groups. The first group, labelled "oncological," comprised patients with a previous history of malignancy; the second group, labelled "naïve," included patients with no relevant history. Pathology records were retrieved to record microscopic findings, namely, background appearance, group architecture, and specific cell features; data from cell block (CB) preparations were also collected. RESULTS Overall, 982 cases were selected: 497 cases (50.61%) in the naïve group, and 485 (49.39%) in the oncological group. Overall, a second diagnostic level was achieved in 834/982 cases (84.92%); cases diagnosed as carcinoma not otherwise specified were more frequent in the naïve group than in the oncological group (17.51% vs. 8.04%, P < 0.01). Notably, although CB material was available in only 44.87% of the naïve cases, we were able to achieve a second diagnostic level thanks to the integration of clinical and cytomorphological findings, plus lymph node topography, in 82.49% of the cases. CONCLUSION Our results confirmed that in a metastatic setting, FNC can reliably lead to the identification of the origin of the primary tumour.
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Affiliation(s)
- Gennaro Acanfora
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
| | - Antonino Iaccarino
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
| | | | - Pasquale Pisapia
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
| | - Caterina De Luca
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
| | - Claudia Giordano
- Hematology Section, Department of Clinical Medicine and SurgeryUniversity of Naples "Federico II"NaplesItaly
| | | | - Marco Picardi
- Hematology Section, Department of Clinical Medicine and SurgeryUniversity of Naples "Federico II"NaplesItaly
| | - Giancarlo Troncone
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
| | - Elena Vigliar
- Department of Public HealthUniversity of Naples "Federico II"NaplesItaly
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Fei F, Natkunam Y, Zehnder JL, Stehr H, Gratzinger D. Diagnostic Impact of Next-Generation Sequencing Panels for Lymphoproliferative Neoplasms on Small-Volume Biopsies. Am J Clin Pathol 2022; 158:345-361. [PMID: 35552630 DOI: 10.1093/ajcp/aqac045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We investigated the feasibility and utility of next-generation sequencing (NGS)-based targeted somatic mutation panels and IG/TR gene rearrangement assays in the diagnosis of lymphoproliferative disorders (LPDs) in small-volume biopsies. MATERIALS We performed a retrospective, single-institution review of all NGS assays requested over a 3-year period by hematopathologists for diagnostic purposes on small-volume biopsies. RESULTS We identified 59 small-volume biopsies. The TR assay was most commonly requested (42 [71%]), followed by the somatic mutation panel (32 [54%]) and IG assay (26 [44%]). NGS studies were associated with a change in the diagnostic line in about half of cases (28 [47%]) and in a change in the likelihood of a diagnosis in a further 16 cases (27%); there was no diagnostic impact of NGS testing in 15 cases (25%). CONCLUSIONS Implementation of NGS panel somatic mutation or IG/TR gene rearrangement assays on small-volume biopsies contributes to the diagnosis of LPDs in the majority of select cases for diagnostic purposes. The molecular diagnosis is considered in the context of the clinical, histologic, and immunophenotypic findings and does not by itself lead to a definitive diagnosis in small-volume biopsies.
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Affiliation(s)
- Fei Fei
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - James L Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Henning Stehr
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
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Uzun E, Erkilic S. Diagnostic accuracy of Thinprep® in cervical lymph node aspiration: Assessment according to the Sydney system. Diagn Cytopathol 2022; 50:253-262. [PMID: 35148033 DOI: 10.1002/dc.24943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is a reliable technique that has been used for many years in lymphadenopathy diagnosis. Although conventional smear is the standard approach in FNAC, liquid-based cytology (LBC) is accepted as an alternative method. Reporting standardization is a significant gap in fine-needle aspiration cytology, leading to failure in pathologist-clinician dialog and interobserver variability. In 2020, an expert panel proposed the Sydney system for classifying and reporting lymph node aspiration cytology. This study aimed to evaluate the diagnostic accuracy of LBC in lymph node aspiration cytology under the guidance of the Sydney system. METHODS Five hundred-four LBC samples were reevaluated and classified according to the Sydney system. Of these, n = 24 were categorized as L1-inadequate/non-diagnostic, n = 283 as L2-benign, n = 36 as L3- atypical cells of undetermined significance/atypical lymphoid cells of uncertain significance (AUS/ALUS), n = 48 as L4-suspicious, and n = 113 as L5-malignant. Four hundred-one samples were histopathologically confirmed. The diagnostic accuracy of LBC and the risk of malignancy for each Sydney category were calculated. RESULTS The results were as follows: sensitivity 98.97%; specificity 98.60%; positive predictive value 94.80%; negative predictive value 99.29%; and overall diagnostic accuracy 98.75%. The ROM was 16.6% for L1, 0.7% for L2, 88.8% for L3, and 100% for L4 and L5. CONCLUSION LBC is suitable for use in lymph node aspiration under the guidance of the Sydney system and has high diagnostic accuracy. Future comprehensive studies will increase the applicability of the Sydney system and minimize interobserver variability.
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Affiliation(s)
- Evren Uzun
- Department of Pathology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Suna Erkilic
- Department of Pathology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Perincheri S. Tumor Microenvironment of Lymphomas and Plasma Cell Neoplasms: Broad Overview and Impact on Evaluation for Immune Based Therapies. Front Oncol 2021; 11:719140. [PMID: 34956859 PMCID: PMC8692247 DOI: 10.3389/fonc.2021.719140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/16/2021] [Indexed: 12/20/2022] Open
Abstract
Lymphomas and plasma cell neoplasms are a heterogenous group of malignancies derived from lymphocytes. They are a significant cause of patient morbidity and mortality. Advances in morphologic, immunophenotypic and molecular techniques have led to better understanding of the pathogenesis and diagnosis of these neoplasms. Advances in treatment, particularly immune-based therapies, increasingly allow for targeted therapies of these diseases. Mechanistic studies using animal models and clinical trials have revealed the importance of the tumor microenvironment on disease pathogenesis, progression, and response to therapy in these malignancies. Simultaneous progress in diagnostic techniques has made it feasible to generate high-resolution, high-throughput data from the tumor microenvironment with spatial context. As the armamentarium of targeted therapies and diagnostic techniques grows, there is potential to harness these advances to better stratify patients for targeted therapies, including immune-based therapies, in hematologic malignancies.
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Affiliation(s)
- Sudhir Perincheri
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
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Vigliar E, Acanfora G, Iaccarino A, Mascolo M, Russo D, Scalia G, Della Pepa R, Bellevicine C, Picardi M, Troncone G. A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System. Diagnostics (Basel) 2021; 11:1314. [PMID: 34441249 PMCID: PMC8393909 DOI: 10.3390/diagnostics11081314] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022] Open
Abstract
Fine-needle cytology (FNC) is a useful diagnostic tool in the first line evaluation of lymphadenopathy of unknown aetiology. Nevertheless, considering the large number of conditions presenting as lymphadenopathy, lymph node cytology represents a challenging scenario. Recently, an expert panel published the proposal of the Sydney system for performing classification and reporting of lymph node cytopathology; the aim of the present study was to evaluate the applicability of this system. Thus, 300 lymph node FNCs performed over 1 year were reviewed and categorized according to the Sydney system classification. Overall, n = 20 cases (6.7%) were categorized as L1-inadequate/non-diagnostic; n = 104 (34.7%) as benign (L2); n = 25 (8.3%) as atypical (L3); n = 13 (4.3%) as suspicious (L4), and n = 138 (46%) as malignant (L5). FNC diagnoses were correlated with histopathologic and clinical follow-up to assess the diagnostic accuracy and the risk of malignancy (ROM) for each diagnostic category. Statistical analysis showed the following results: sensitivity 98.47%, specificity 95.33%, positive predictive value 96.27%, negative predictive value 98.08%, and accuracy 97.06%. The ROM was 50% for the category L1, 1.92% for L2, 58.3% for L3, and 100% for L4 and L5. In conclusion, FNC coupled with ancillary techniques ensures satisfactory diagnostic accuracy and the implementation of the Sydney system may improve the practice of cytopathologists.
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Affiliation(s)
- Elena Vigliar
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Gennaro Acanfora
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Antonino Iaccarino
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (G.A.); (M.M.); (D.R.)
| | - Giulia Scalia
- Laboratory of Clinical Research and Advanced Diagnostics, CEINGE Biotecnologie Avanzate, 80131 Naples, Italy;
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.P.); (M.P.)
| | - Claudio Bellevicine
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80131 Naples, Italy; (R.D.P.); (M.P.)
| | - Giancarlo Troncone
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (E.V.); (A.I.); (C.B.)
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Mou E, Falchi L, Sundaram V, Abramson JS, Balassanian R, Beygi S, Fitzpatrick MJ, Frank AK, Gupta S, Lin O, Long SR, Menke JR, Reed DR, Ruiz-Cordero R, Volaric AK, Xie Y, Wang L, Wen KW, Zadeh SL, Natkunam Y, Cheung MC, Gratzinger D. Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation. Leuk Lymphoma 2021; 62:2864-2872. [PMID: 34176413 DOI: 10.1080/10428194.2021.1941936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosis of histologic transformation (HT) of follicular lymphoma (FL) requires tissue biopsy. While surgical biopsy represents the gold standard, less invasive procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) are frequently performed. In this retrospective multi-institutional study including 269 patients with FL and suspected HT, the median time from initial clinical suspicion to final diagnostic biopsy was similar whether the workup began with FNAB, CNB, or surgical biopsy (4, 9, and 6 days, respectively; p=.27), despite more subsequent biopsies performed following initial FNAB. Periprocedural complications were uniformly minimal. Biopsy-proven HT was more common in the initial surgery group and in workups including positron emission tomography/computed tomography (PET/CT). Our findings, derived from US academic centers with specialized procedural and pathology expertise, suggest that FNAB, CNB, and surgical biopsy are all viable initial diagnostic procedures that can inform clinical decision-making in select FL patients with suspected HT.
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Affiliation(s)
- Eric Mou
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA.,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vandana Sundaram
- Quantitative Science Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sara Beygi
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Annabel Kate Frank
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Daniel R Reed
- Section of Hematology and Oncology, Wake Forest Baptist Medical Comprehensive Cancer Center.,Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Ashley K Volaric
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Linlin Wang
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience. J Am Soc Cytopathol 2021; 10:543-557. [PMID: 34088642 DOI: 10.1016/j.jasc.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although the diagnostic utility of lymph node fine-needle aspiration (FNA) is well established in the evaluation of metastatic malignancy, its value in the diagnosis of lymphoma is more controversial; yet, there is a growing trend among practitioners towards less-invasive procedures such as FNA and core needle biopsy (CNB). The guidelines recently published by the American Society for Clinical Pathology/College of American Pathology (CAP) regarding the workup of lymphoma include recommendations on the value and limitations of FNA. MATERIALS AND METHODS We reviewed 1237 image-guided lymph node aspirates from 695 procedures (410 nodes from 360 ultrasound [US]-guided cases, 799 from 309 endobronchial ultrasound [EBUS], 25 from 23 endoscopic ultrasound [EUS], and 3 from 3 computed tomography [CT]). RESULTS The majority (40 of 46, 87%) of lymph nodes suspected of lymphomatous involvement were aspirated under ultrasound. Core needle biopsy [CNB] was obtained for 41 (89%) lymph nodes, including all 40 US specimens. Flow cytometry (FC) was performed on 37 (80%) aspirates; aspirates without FC were from patients who had a history of Hodgkin lymphoma, or showed granulomata or non-hematologic malignancy onsite. Thirty-one (67%) lymph nodes were sent for review by hematopathology. Forty-two (91%) lymph node FNA/CNB yielded actionable diagnoses. Seventeen of 241(7%) cases aspirated for other indications (14 US, 3 EBUS) were involved by a lymphoproliferative process. All were reviewed by hematopathology. All 14 US cases had FC and CNB. CONCLUSION Our institutional approach towards lymph node cytopathology for lymphoma workup appears to be in accordance with the new CAP guidelines, and demonstrates a potential triage and workflow model for lymph node FNA specimens that allows for accurate diagnosis in cases where lymphoma is a consideration.
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Alrajjal A, Choudhury M, Yang J, Gabali A. Cell-blocks and hematolymphoid lesions. Cytojournal 2021; 18:7. [PMID: 34221096 PMCID: PMC8248082 DOI: 10.25259/cytojournal_10_2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Cell-blocks are an important component for evaluation for hematolymphoid lesions. They are especially critical for immunocharacterization of the lymphoid population especially when flow cytometry is not available or cannot be performed. In addition, cell-blocks allow various molecular pathology tests including gene rearrangement studies and FISH, proteomics analysis, and microbiology/histochemical special stains. Fine-needle aspiration (FNA) for mass lesions, lymphadenopathy, and effusion fluids are common cytopathology specimens which are frequently cell-blocked. The differential diagnosis of enlarged lymph nodes (LNs) and mass lesions is broad and includes reactive processes, granulomatous lesions and malignancies including solid tumor metastases and various types of hematological malignancies, of which lymphoma would be most common. Depending on the patient population, most lymphomas may be diagnosed with immunocharacterization on cell-block or/and flow cytometry in concert with excellent cytomorphology in Diff-Quik stained FNA aspirate smears. However, a proportion of lymphoma cases (up to 12-30%) may still require an excisional LN biopsy to evaluate architectural parameters. Similarly, various effusion fluids suspicious for lymphoma can be immunocharacterized by immunostaining of cell-block sections (or/and by flow cytometry). Availability of quantitatively and qualitatively optimum cell-blocks of specimens to be evaluated for hematolymphoid processes is critical for immunohistochemistry, polymerase chain reaction, in situ hybridization (FISH), and gene expression profiling studies.
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Affiliation(s)
- Ahmed Alrajjal
- Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
| | - Moumita Choudhury
- Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
| | - Jay Yang
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
| | - Ali Gabali
- Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan, United States
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