Diagnostic role of cytology in serous effusions of patients with hematologic malignancies

Abstract

Background We investigated serous effusions occurring during the course of an already known hematologic neoplasia or as a first manifestation of it. We correlated cytology results with flow cytometry results, when available. In the absence of flow cytometry, our correlation was based on clinical follow up information obtained retrospectively. We evaluated our results in relation to the data of the literature and we considered some new suggestions for the improvement of cytology service. Methods Serous effusions in hematologic patients were retrieved from the files of the Department of Cytology, Laiko Hospital, for a period of 2 years. All patients had enrolled either a previous hematologic history, or a suspicious clinical and imaging status. Seventy‐three serous effusions were included. Cytology reports consisting of morphology and immunocytochemistry assessment were correlated to flow cytometry results and, occasionally, to clinical follow‐up. Results In the group of patients with previous history, sensitivity was 82.76%, positive predictive value was 100%, specificity 100%, and negative predictive value was 58.33%. In the group of patients without previous history, sensitivity and positive predictive value were both 91%, whereas specificity and negative predictive value could not be estimated. Conclusion We provide evidence that the diagnostic accuracy of cytology with the adjunct of immunocytochemistry is high compared to flow cytometry for detecting hematologic malignancies. In order to improve clinical performance, it is suggested that a cytology triage of serous effusions in all patients with hematologic malignancy must be implemented.

Clinical and cytopathologic characteristics of lymphoid neoplasms involved with serous effusions: a single center experience

“…Wright-Giemsa staining and Papanicolaou staining [3,4] were performed on alcohol-fixed smears and/ or liquid-based preparation slides. DiffQuik® staining [12] was performed on air-dry slides for some cases.…”

“…Cytologic analysis of pleural effusion (PE), ascites, or pericardial effusion was often the first-line diagnostic test performed after an effusion was detected [1][2][3]. It was simple, safe, fast and cost effective.…”

“…It was simple, safe, fast and cost effective. It reduced all of the possible consequences and complications of a more aggressive biopsy procedure [3,4]. However, lymphoid neoplasms in serous effusions (SEs) were uncommon, and the diagnosis of lymphoid neoplasms in SEs was still challenging.…”

“…Cytopathologic diagnoses could determine whether or not neoplastic cells were present in SEs [2][3][4][5][6], but sometimes it was difficult to determine by cytomorphology alone. For example, indolent 3 lymphoma often mimics a reactive lymphocytosis consisting predominantly of small cells, and plasma cells may present cytomorphologic features nearly identical to mesothelial cells in some effusions.…”

“…Then a combination of clinical features, morphology, and immunophenotype or other ancillary techniques aided the correct diagnosis of lymphoid neoplasms in SEs [3][4][5].…”