Immunoflow cytometry and cell block immunohistochemistry in the FNA diagnosis of lymphoma: a review of 73 consecutive cases

Abstract

Aims-To review the results of 73 consecutive fine needle aspirations (FNAs) that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. Methods-The setting was a large general hospital in rural New Zealand. The FNAs were performed by a pathologist, or a radiologist for image guided localisations. Material for immunoflow cytometry was collected into RPMI and, when required, material for a cell block was collected into formalin. In the past, the cytological diagnosis of lymphomas from fine needle aspiration (FNA) samples has been particularly diYcult. Usually, one obtains a sample that is either obviously malignant but equivocally lymphoid or, conversely, a sample that is obviously lymphoid but equivocally malignant. However, recently FNA diagnosis of lymphoid lesions has been made easier by the arrival of immunoflow cytometry in most large pathology laboratories. Immunoflow cytometry has been used mainly for the analysis of haematological diseases, but increasingly it is being used by cytologists. Early studies of FNAs and immunoflow cytometry used a limited range of antibodies and were not able to perform dual staining. Recently, there have been substantial advances in the sophistication of the methods and equipment used for flow cytometry. It is accepted that FNA cytology with immunolabelled flow cytometry can, in some circumstances, serve as a replacement for open biopsy and conventional histology and immunohistochemistry. Results-Of1 2 However, FNA with immunoflow cytometry is not always successful. Scanty cellularity in the sample can prevent a satisfactory analysis, and even with an adequate sample the results might be misleading. In particular, non-lymphoid malignancies can be hard to distinguish from lymphoid lesions if the sample also contains reactive lymphoid cells; B cell lymphomas sometimes do not exhibit light chain restriction; and T cell lymphomas can have a large population of reactive B cells.The aim of our study was to review the results of 73 consecutive FNAs that were collected by a pathologist and analysed by immunoflow cytometry. Material for a cell block was also collected from some of these lesions. The setting was a large general hospital in rural New Zealand. The FNAs were performed over a two year period. In this time, approximately 800 FNAs of non-breast lesions were performed together with approximately 1400 breast FNAs. MethodsThe FNAs were performed by one of two mobile pathologists with an interest in FNA cytology, except for image guided FNAs, in

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Lymphoma

“…Therefore, excisional biopsy is considered necessary by some authors to confirm these diagnoses (Metzgeroth et al, 2012); however, this is not always possible because of the poor general medical condition of these patients (Ahmed HG et al, 2013). Recent studies have indicated that an accurate diagnosis of lymphoproliferative disorders can be achieved by FNA in 85.9-87% of the cases, particularly when cytology is supported by flow cytometry and immunohistochemistry techniques, representing a powerful first-choice diagnostic technique (Mayall and Dray, 2000).…”

Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-hodgkin lymphoma

“…1,2,[13][14][15] The possibility of applying a complete panel of antibodies and diagnostic algorithms is the most appreciated advantage of the technique; 4,6,8 consequently, many reports stress the high sensitivity in detecting non-Hodgkin lymphoma (NHL) through the combined application of FNC and FC. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The most enthusiastic reports hypothesize that, in the near future, histology will not be necessary strictly for the diagnosis of NHL. In fact, in many institutions, FNC coupled with ancillary techniques like FC routinely has replaced histology in the diagnosis of recurrent NHL (rNHL).…”

T-Cell/Histiocyte–Rich Diffuse Large B-Cell Lymphoma

“…It is, however, limited by the inability to identify a small population of neoplastic cells from among reactive cells and as such could not be used in HL or TCRBL. 17,27,33 Nevertheless, flow cytometry can detect the deletion of certain antigens (such as CD4 and CD5), thereby assisting in the diagnosis of PTCL. 34 Immunocytochemistry on cytospin material, while useful in many cases, 16 suffers from the potential drawback of having to work on ruptured tumor cells.…”