Nodular sclerosis classical Hodgkin lymphoma grade 2: A diagnostic challenge to the cytopathologists

Sharma, Sudha; Dey, Pranab; Mitra, Suvradeep; Rajwanshi, Arvind; Nijhawan, Raje; Srinivasan, Radhika; Gupta, Nalini; Das, Ashim

doi:10.1002/cncy.21799

Cited by 12 publications

(19 citation statements)

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“…[2][3][4][5]9,11,17,27,28 The two main limitations of HL FNAC diagnosis are: [2][3][4][5]9,11,17,27,28 The two main limitations of HL FNAC diagnosis are:…”

Section: Discussionmentioning

confidence: 99%

“…(1) the lower sensitivity and specificity in comparison to diagnoses of NHL obtained using the same procedure [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and (2) peripheral T-cell NHL, 31 mediastinal large B cell lymphoma, in a subset of nodal DLBCL and in follicular lymphoma. 32 Therefore, the diagnostic value of these antigens depends on the histological and cytological context in which their expression is evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…1 This latter is characterized by reactive inflammatory cells of various types and quantity and specific fibrosis of a variable degree (WHO definition). 2,3,5,8,9,11,13,14,17 Therefore, the phenotypical identification of diagnostic cells plays a crucial role in the diagnosis of HL on FNAC. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Since the percentage of diagnostic cells is generally low and not always straightforward (especially in the early stages of the disease), their phenotypical identification is necessary for the diagnosis of HL.…”

Section: Hodgkin's Lymphoma (Hl) Is Morphologically Characterized Bymentioning

confidence: 99%

“…the difficulties and failures in distinguishing specific HL subtypes [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Whereas clinical data and the specific background of HL can guide the cytological evaluation of FNAC, the cytological diagnosis of HL mainly depends on the identification of HC and RSC and their variants [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Whereas clinical data and the specific background of HL can guide the cytological evaluation of FNAC, the cytological diagnosis of HL mainly depends on the identification of HC and RSC and their variants [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

mentioning

confidence: 99%

“…Moreover, phenotype alone is not indicative without the specific cell morphology because of the overlap with other nondiagnostic cells of B-lineage.Finally HC and RSC, mainly in their possible variants or when they lose the cytoplasm during aspiration and smearing may look like other cell types, including histiocytes or immunoblasts 2,3,5,[8][9][10]13. Moreover, phenotype alone is not indicative without the specific cell morphology because of the overlap with other nondiagnostic cells of B-lineage.Finally HC and RSC, mainly in their possible variants or when they lose the cytoplasm during aspiration and smearing may look like other cell types, including histiocytes or immunoblasts 2,3,5,[8][9][10]13.…”

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confidence: 99%

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CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine‐needle aspiration cytology samples

Cozzolino

Vitagliano

Caputo

et al. 2019

Diagnostic Cytopathology

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Background: The phenotypical identification of diagnostic cells is crucial for the diagnosis of Hodgkin's lymphoma (HL) on fine-needle aspiration cytology (FNAC). The aim of this study is to evaluate the immunocytochemical (ICC) expression of CD30, CD15, and PAX5 in Hodgkin's cells (HC) and Reed-Sternberg cells (RSC) on smears and cell-blocks (CB) of HL and to compare the performance of each antibody on smears and CB.Methods: In 21 FNAC cases of histologically confirmed classical HL, ICC identification of HC and RSC was performed using CD15, CD30, and PAX5 on smears and CB, respectively.Results: CD30 was positive in 19/21 cases (90.5%; 11/11 smears and 8/10 CB), CD15 was positive in 14/21 cases (66.7%; 5/11 smears and 9/10 CB), and PAX5 was positive in 13/21 cases (61.9%; 9/11 smears and 4/10CB).Conclusions: CD15, CD30, and PAX5 are useful to the FNAC identification of HC and RSC. CD30 is the most sensitive, followed by CD15 and PAX5, which are more effective on CB and smears, respectively. K E Y W O R D SCD15, CD30, fine-needle aspiration cytology, Hodgkin lymphoma, PAX5

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“…[2][3][4][5]9,11,17,27,28 The two main limitations of HL FNAC diagnosis are: [2][3][4][5]9,11,17,27,28 The two main limitations of HL FNAC diagnosis are:…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Hodgkin's Lymphoma (Hl) Is Morphologically Characterized Bymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine‐needle aspiration cytology samples

Cozzolino

Vitagliano

Caputo

et al. 2019

Diagnostic Cytopathology

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Assessment of risk of malignancy by application of the proposed Sydney system for classification and reporting lymph node cytopathology

Gupta

Kumar

et al. 2021

Cancer Cytopathology

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BACKGROUND Fine‐needle aspiration cytology (FNAC) is one of the most commonly used techniques for evaluating lymphadenopathy. Recently, the Sydney system was proposed for assessing the performance, classification, and reporting of lymph node (LN) cytopathology. The present study was conducted to assess the risk of malignancy associated with each of the diagnostic categories of the proposed Sydney system. METHODS This was a 2‐year retrospective study of LN‐FNAs; cytologic diagnoses were categorized by the proposed Sydney system. Cytological diagnoses were correlated with the corresponding histopathological diagnoses to assess diagnostic accuracy and risk of malignancy for each diagnostic category. RESULTS Of 23,335 FNAs during the study period, 6983 (30%) were performed on LNs. Of these, 289 (4.1%) cases were reported as nondiagnostic/inadequate (L1); 3397 (48.6%) were reported as benign (L2); 33(0.5%) as atypical cells of undetermined significance (L3), 96 (1.4%) as suspicious for malignancy (L4) and 3168 (45.4%) as malignant (L5). Subsequent histopathology was available for 618 (8.8%) cases. On cytohistopathologic correlation, 552 (89.3%) were concordant and 66 (10.7%) discordant. The overall sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LN‐FNA were 79.9%, 98.7%, 98.4%, 83.1%, and 89.3%, respectively. The risk of malignancy was 27.5% for the nondiagnostic category, 11.5% for the benign, 66.7% for the atypical, 88% for the suspicious, and 99.6% for the malignant categories. CONCLUSIONS FNAC has high diagnostic accuracy for the diagnosis of various LN pathologies. Application of the proposed Sydney system can help in achieving uniformity and reproducibility in cytologic diagnoses and also help in risk‐stratification on cytology.

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Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories

Makarenko

DeLelys

2021

Cancer Cytopathology

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Background Despite widespread clinical use, lymph node fine‐needle aspiration cytology (LN‐FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely due to reports of lower diagnostic performance, inconsistent terminology use in cytopathology diagnostic reports, and only limited data on the clinical implications of LN‐FNAC diagnoses. Recently, a uniform LN‐FNAC cytopathological diagnostic reporting system was proposed (the Sydney System). This study evaluated LN‐FNAC diagnostic performance and risks of malignancy associated with the proposed diagnostic categories. Methods LN‐FNAC specimens obtained in 2018‐2019, with and without concurrent core biopsy, to evaluate for suspected lymphoma were analyzed (n = 349). LN‐FNAC diagnoses were compared with final diagnoses obtained via subsequent tissue biopsy and/or clinical assessment. Results The mean patient age was 57.6 years, and 41% were female. LN‐FNAC was the initial diagnostic test in 223 (63.9%), and it was used to evaluate for recurrence in 126 (36.1%). LN‐FNAC diagnosed 202 hematological malignancies (57.9%), 23 nonhematological malignancies (6.6%), and 124 reactive processes (35.5%). Subsequent tissue biopsy was performed in 42 (12%). The risks of malignancy per diagnostic category were as follows: inadequate, 58.3%; benign, 6.4%; atypical, 69.2%; suspicious, 96.7%; and malignant, 99.3%. LN‐FNAC demonstrated up to 96.3% sensitivity, 91.91% specificity, and 87.35% accuracy. Optimal specimen quality and the use of intradepartmental consultation reduced diagnostic error rates in FNA cases without concurrent core biopsy (P = .029 and P = .0002 respectively). Conclusions LN‐FNAC is accurate and reliable for the diagnosis of lymphoma. Inadequate LN‐FNAC samples should be resampled due to a significant associated risk of lymphoma. The diagnostic performance of LN‐FNAC may be improved with good specimen quality and reviews by multiple pathologists. Understanding the risks of malignancy associated with LN‐FNAC diagnostic categories will help to guide optimal patient management.

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Nodular sclerosis classical Hodgkin lymphoma grade 2: A diagnostic challenge to the cytopathologists

Abstract: The diagnostic efficacy of FNAC is much lower for grade 2 NSCHL versus grade 1 NSCHL. The search for an occasional RS cell and the identification of lacunar cells can provide a clue for the diagnosis. Cancer Cytopathol 2017;125:104-113. © 2016 American Cancer Society.

Cited by 12 publications

References 12 publications

CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine‐needle aspiration cytology samples

CD15, CD30, and PAX5 evaluation in Hodgkin's lymphoma on fine‐needle aspiration cytology samples

Assessment of risk of malignancy by application of the proposed Sydney system for classification and reporting lymph node cytopathology

Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories

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