Differential Diagnosis of Malignant Lymphadenopathy Using Flow Cytometry on Fine Needle Aspirate: Report on 269 Cases

Abstract

Introduction: Fine needle aspiration (FNA) is frequently the first noninvasive test used for the diagnostic workup of lymphadenopathy. There have been many studies showing its usefulness, especially in conjunction with other techniques for the diagnosis of lymphoma, but it remains inferior to histological examination. The data regarding this subject have mostly been reported mostly from first-world countries, but are scarce for emerging economies. Thus, the current study assesses the agreement between fine needle aspiration flow cytometry (FNA FC) and histology in the aforementioned region. Material and Methods: We conducted a retrospective study including the FNA FC adenopathy diagnoses made between January 2011 and December 2016 at the Tygerberg Hospital, Cape Town, South Africa. Additional variables included were the histological diagnosis, sex and age of the included patients. Results: In the descriptive part of the current study, 269 FNA FC samples were included. The most frequent diagnoses made on these were represented by B-cell lymphoma, reactive adenopathy, no abnormality detected (NAD), and non-hematological malignancy. In the analytical part of the current study, there were 115 cases included that had both valid FNA FC and histological diagnoses. It could be observed that FNA FC can correctly diagnose B-cell lymphoma in most cases, but it is a poor diagnostic tool especially for Hodgkin lymphoma in this setting as only a four-color flow cytometer was available for diagnosis. Moreover, FNA FC diagnosis of reactive adenopathy and of no abnormalities detected was shown to frequently hide a malignant disease. Conclusion: In countries with scarce resources, FNA FC represents a useful diagnostic tool in the case of B-cell lymphoma, but may misdiagnose reactive adenopathy. Thus, FNA FC should be used in a case-specific manner, in addition to as a screening tool, with the knowledge that in cases with a high clinical suspicion of lymphoma, histological diagnosis is a necessity.

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto‐Heme Interinstitutional Collaborative study

“…We found that CB acquisition was associated with minimal improvement in diagnostic yield relative to FNA alone, suggesting that addition of CB alone, although helpful, usually does not result in a complete WHO classification of FL at initial diagnosis, and many patients may still require a subsequent, larger biopsy. Flow cytometry has become a standard ancillary diagnostic tool for the identification and subclassification of lymphoma 30,31 . We found a similar rate of repeat biopsies across all three clinical indications evaluated regardless of whether or not flow cytometry was performed, and despite relatively high rates of flow cytometry adequacy across all biopsy types and all clinical indications.…”

Flow cytometry assessment of reactive T‐cells distinguishes classic Hodgkin lymphoma from benign lymphadenopathy in children

“…Classic Hodgkin lymphoma (cHL) is an unusual form of lymphoma characterized by a small number of neoplastic Hodgkin and Reed–Sternberg (HRS) cells in an extensive inflammatory background 1,2 . In light of the frequent non‐neoplastic causes of lymphadenopathy and involvement of sensitive locations, lymph node fine‐needle aspiration (FNA) or core needle biopsy (CNB) as minimally invasive procedures are frequently the first alternatives to obtain lymph node tissue to diagnose lymphoproliferative disorders 3,4 . However, insufficient tissue or the relatively sparse distribution of HRS cells decreases the diagnostic accuracy of cHL using conventional histologic evaluation 5 .…”

“…1,2 In light of the frequent non-neoplastic causes of lymphadenopathy and involvement of sensitive locations, lymph node fine-needle aspiration (FNA) or core needle biopsy (CNB) as minimally invasive procedures are frequently the first alternatives to obtain lymph node tissue to diagnose lymphoproliferative disorders. 3,4 However, insufficient tissue or the relatively sparse distribution of HRS cells decreases the diagnostic accuracy of cHL using conventional histologic evaluation. 5 Therefore, more sensitive and efficient ancillary tools such as flow cytometry (FCM) can provide unique diagnostic information when the morphologic analysis is unclear.…”

Clinical Remission in a 72-Year-Old Patient with a Massive Primary Cutaneous Peripheral T-Cell Lymphoma-NOS of the Eyelid, Following Combination Chemotherapy with Etoposide Plus COP

“…Cutaneous lymphomas exhibit various clinical, histological, immunophenotypic, and genetic features. Moreover, they differ in prognosis and treatment from systemic lymphomas with similar histological features [ 5 , 6 , 7 , 8 ]. Up to 75–80% of cutaneous lymphomas originate from T-cells, and only 20–25% from B-cells [ 9 , 10 , 11 ].…”