Fine-Needle Aspiration Biopsy in the Evaluation of Lymphadenopathy Associated With Cutaneous T-Cell Lymphoma (Mycosis Fungoides/Sézary Syndrome)

Abstract

We studied the role of fine-needle aspiration (FNA) in the evaluation of lymphadenopathy associated with cutaneous T-cell lymphoma (CTCL) in 11 patients with lymphadenopathy and compared findings with corresponding histologic material. Molecular genetic analysis for T-cell clonality by polymerase chain reaction (PCR) was performed on all aspirates. Immunophenotyping was successful in 4 of 7 cases in which flow cytometry was attempted from the aspirated material. Cytologic evaluation of FNA samples correlated strongly with histologic rating of involvement based on numbers of atypical cerebriform lymphocytes in the nodal specimen. Of 7 nodal specimens with scattered or small groups of atypical cells in the background of dermatopathic lymphadenopathy (LN1-2), the cytologic diagnosis was interpreted as reactive in all instances. Of 4 specimens with highly suspect (LN3) or definite histologic involvement (LN4), the cytologic diagnosis was likewise suspect or malignant. The correlation between molecular genetic studies on FNA samples and studies on tissue was not significant; in 2 cases, a T-cell clone was detected in the nodal tissue sample but not in the FNA sample, suggesting undersampling. A T-cell clone was detected by PCR in 5 of 7 nodal specimens judged reactive by FNA biopsy or histologic assessment. FNA for cytologic and molecular genetic analysis is a useful method to evaluate lymphadenopathy associated with CTCL and may obviate the need for surgical biopsy.

Adult T-cell leukemia/lymphoma

“…4,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In the REAL classification, ATLL belongs to the category of peripheral T-cell and natural killer cell neoplasms. Although several reports of peripheral Tcell lymphoma have been published in the cytology literature, [33][34][35][36][37] we are aware of only a single cytologic study of T-cell lymphoma in HTLV-1 positive patients. 38 In our study, we reviewed 114 samples from 34 patients already diagnosed with ATLL, from diverse anatomic sites.…”

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

“…Since excisional lymph node biopsies put the patient at risk for sepsis, especially in erythrodermic patients whose skin is often colonized with Staphylococcus, alternative methods to obtain nodal tissue (core biopsy or fine needle aspiration [FNA]) have been suggested as potential substitutes particularly if combined with flow cytometry. 70 However, these alternate methods may have inadequate or poorly representative sampling 71 or incomplete concordance with excisional biopsy results, 72,73 and they do not provide the histopathologic assessment of nodal architecture necessary for N staging. For personal use only.…”

Strategies to diagnose lymphoproliferative disorders by fine-needle aspiration by using ancillary studies

“…In these instances, PCR can aid in the diagnosis by detecting T-cell receptor (TCR) gene arrangements that are present in most T-cell lymphomas. 10,58 Approximately 5-7 million cells are typically needed for this procedure.…”