Fine-needle aspiration (FNA) cytology of lymph nodes in malignant lymphoma is fraught with difficulty. In certain clinical situations, cytology has been documented to be useful in patients with malignant lymphoma. The intent of our investigation was to determine the accuracy of a multiparameter approach in diagnosing lymphoma. We reviewed the results of FNA cytology combined with the immunocytochemistry and, in some cases, the Southern blots of aspirated cell suspensions obtained from 86 suspected lymphoma patients who subsequently underwent surgical biopsy of the aspirated site. In four cases, in which FNA was unable to retrieve sufficient material for diagnosis, the histology showed extensive fibrosis. When the FNA diagnoses were compared with the histologic diagnoses, the diagnosis concurred in 69 cases (56 malignant lymphomas, 12 reactive, 1 atypical lymphoid proliferation). There was one false-positive, six false-negatives, and eight cases diagnosed as atypical lymphoid proliferation. Overall accuracy was 91%. There were two types of false-negative cases: those in which a diagnosis of another malignancy or unspecified malignant neoplasm was made and those that were diagnosed as reactive when the histology showed lymphoma. In seven cases, the DNA rearrangement studies of the antigen receptor genes were successfully performed on the aspirated cells and were useful in establishing lineage and clonality of both B and T lymphoid cells. Our study indicated that the use of a multiparameter approach in the diagnosis of malignant lymphoma by FNA enhanced the accuracy of diagnosis of the non-Hodgkin's lymphomas. In Hodgkin's disease, no benefit was derived from the approach.

Blinded review has been shown to be an excellent method to detect disagreements and errors and improve performance in gynecologic cytology. Preliminary studies suggest it may be valuable in surgical pathology. We reviewed 5,000 sequential outpatient surgical pathology biopsy cases without knowledge of the original diagnosis or history and compared the results with those of the original diagnosis. Complete agreement was obtained in 91.12% of cases. The technique of blinded review of surgical pathology biopsy material had a sensitivity of more than 99%, failing to identify an abnormality in 19 cases. Although there was a significant level of diagnostic disagreement (444 cases), primarily due to differences in diagnostic thresholds (292 cases), diagnoses that resulted in a change in the original report (true errors) were present in only 5 cases, and only 4 were clinically significant. This clinically significant error rate of 0.08% is significantly lower than previously published error rates. Blinded review is a sensitive (99%) and effective method to identify areas of disagreement and errors in surgical pathology biopsy material. The relatively high rate of disagreement found with blinded review coupled with the very low rate of error highlights the substantial potential for bias in nonblinded reviews.

Recent reports suggest that the finding of lobular neoplasia (atypical lobular hyperplasia [ALH] or bular carcinoma in situ [LCIS]) in breast core needle biopsy specimens may be associated with an increased risk of both ductal carcinoma in situ (DCIS) or invasive carcinoma at excision. We reviewed our breast core biopsy material to see if we could confirm this finding. from 4,297 biopsies, 71 cases of lobular neoplasia lone and 35 cases of lobular neoplasia associated with typical ductal hyperplasia were identified. Biopsy follow-up revealed DCIS or invasive carcinoma in none of 6 cases of ALH, none of 9 cases of LCIS, and DCIS in 1 of 11 cases with both atypical ductal hyperplasia and LCIS. Our results suggest that patients with lobular eoplasia in breast core biopsy specimens are not at increased risk of either DCIS or invasive carcinoma at excision, and patients with this finding and no other linical or pathologic indications for biopsy can be llowed up rather than routinely undergo excision.

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Blinded review has been shown to be an excellent method to detect disagreements and errors and improve performance in gynecologic cytology. Preliminary studies suggest it may be valuable in surgical pathology. We reviewed 5,000 sequential outpatient surgical pathology biopsy cases without knowledge of the original diagnosis or history and compared the results with those of the original diagnosis. Complete agreement was obtained in 91.12% of cases. The technique of blinded review of surgical pathology biopsy material had a sensitivity of more than 99%, failing to identify an abnormality in 19 cases. Although there was a significant level of diagnostic disagreement (444 cases), primarily due to differences in diagnostic thresholds (292 cases), diagnoses that resulted in a change in the original report (true errors) were present in only 5 cases, and only 4 were clinically significant. This clinically significant error rate of 0.08% is significantly lower than previously published error rates. Blinded review is a sensitive (99%) and effective method to identify areas of disagreement and errors in surgical pathology biopsy material. The relatively high rate of disagreement found with blinded review coupled with the very low rate of error highlights the substantial potential for bias in nonblinded reviews.