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Fine needle aspiration as a diagnostic technique in B-cell non-hodgkin lymphoma
Amani Sorour, Maged Mikhail, Nahala Farahat, Ashraf Elghandour, Hanna Donia
Experimental Hematology, Volume 42, Issue 8, Supplement, August 2014, Page S61
The role of fine-needle aspiration biopsy (FNAB) in the primary diagnosis and subclassification of Non Hodgkin lymphoma (NHL) has been under intensive debate for a long time. The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues 2008 is based on their cytomorphologic, immunophenotypic, and genetic features. These criteria can be applied to cytological specimens. Aim: To evaluate the value of lymph node FNAB in the diagnosis and subclassification of B-NHL according to WHO classification 2008.
The study was conducted on 129 patients with lymphadenopathy and a clinical suspicion of Lymphoproliferative disorder. 122 specimens were submitted for flowcytometric immunophenotyping (FCI). Fluorescence in-situ hybridization (FISH) analysis was performed on 20 out of 48 cases diagnosed as B-NHL (by cytomorphology and FCI) for t(11;14)(q13;q32) and/or t(14;18)(q32;q21).
Analyzing the clinical data, cytomorphology, FCI, and FISH results, definitive diagnosis was reached in 116/129 (90%) cases. These included: benign lymphadenopathy (45 cases), B-NHL (48 cases), T-NHL (7 cases), Hodgkin lymphoma (8 cases), and others (8 cases).48 cases had a diagnosis of B-NHL. Of these, 33 cases (33/48) could be subclassified according to WHO 2008 as follows: SLL (3 cases), CLL (5 cases), Richter's syndrome (2 cases), MCL (4 cases), low grade FL (1 case), LPL (2 cases), B-lymphoblastic lymphoma (1 case), B -ALL (1 case), Burkitt lymphoma (3 cases), DLBCL (10 cases), and DLBCL/FL (1 case). The remaining 15 cases were reported as B-NHL-NOS. For validation studies of FNA as a diagnostic method the estimated diagnostic sensitivity of FNA combined with ancillary studies in distinguishing between reactive and malignant lymphoid proliferations was 98.39%, with 100% specificity and 98.89% diagnostic accuracy. Sensitivity, specificity, and diagnostic accuracy of the FNA in B-NHL diagnosis were 98.04%, 100%, and 98.89% respectively.
Lymph node FNA offers a simple, safe, and minimally invasive procedure for diagnosis and subclassification of B-NHL.