The Value of Transformed Lymphocyte Count in Subclassification of Non-Hodgkin’s Lymphoma by Fine-Needle Aspiration

Abstract

No established criteria exist for predicting lymphoma grade or transformation in cytologic material. We counted transformed lymphocytes in fine-needle aspiration (FNA) biopsy specimens to determine whether the percentage of these cells in the smear could predict the histologic grade, the biologic behavior, or both.The percentage of transformed lymphocytes out of total lymphoid cells was determined on Papanicolaou-stained smears. Afterward, a cytodiagnosis was based on clinical information available at the time of the FNA, cytomorphologic data, and flow cytometry data. Results were correlated with results of examination of the surgical biopsy specimen, clinical behavior of the lymphoma, or both.The application of fine-needle aspiration (FNA) cytology in the diagnosis and management of malignant lymphoma is still controversial.1-4 Major limitations of this technique include overlap of cytologic patterns between some benign and malignant processes and the inability to determine architectural patterns. 5,6The revised European-American classification system of lymphoid neoplasms (REAL) places a greater emphasis on cytomorphologic examination in combination with immunophenotyping and molecular studies rather than on architectural pattern.7 This new classification system may expand the role of cytology in lymphoma diagnosis, particularly for This research was supported in part by a grant from BristolMyers Squibb, Oncology, Princeton, NJ, and was presented at the 44th Annual Scientific Meeting of the American Society of Cytopathology, November 6-7,1996.Manuscript received December 4, 1996; revision accepted January 23,1997.Address reprint requests to Dr Young: Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111.The percentage of transformed lymphocytes was 10% or less in all low-grade or indolent lymphomas. Aspirates with transformed lymphocyte counts of 20% or greater were aggressive lymphomas. We also report our experience in the diagnosis of non-Hodgkin's lymphoma by FNA using cytomorphologic examination and immunophenotyping by flow cytometry at a cancer referral hospital. This is a preliminary study, and larger series may help establish the ranges of transformed lymphocyte counts that correlate with the lymphoma subtype.

Grading follicular lymphoma on fine-needle aspiration specimens-A practical approach

“…Grading FL is based on the proportion of centroblasts in neoplastic follicles; therefore, the ability to identify the various cellular components in a fine-needle aspirate is the first essential step to the grading process 6,7 (Table 1). FL is comprised of centrocytes; cleaved cells, which are small and large; and centroblasts, which are large, nucleolated, noncleaved cells.…”

“…6). Sun et al 9 recognized the presence of follicular structures in aspirates and determined that it is possible to grade FL on FNA cytologic preparations by determining the percentage of centroblasts in follicles in Papanicolaou-stained smears after a diagnosis of FL is established by cyto- In a previous study, Young et al 6 also graded lymphomas by counting the percentage of centroblasts (transformed lymphocytes) per hpf in Papanicolaou-stained smears. The overwhelming majority of aggressive lymphomas had a transformed lymphocyte count of Ն 20%.…”

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

“…In grading lymphomas, some authors have loosely adapted the Mann and Berard method, 52 which is based on the number of centroblasts per high-power field, to cytologic preparations. 15 Young et al 53 counted the number of transformed lymphocytes in aspirates and found that the percentage of transformed lymphocytes was 10% or less in indolent lymphomas and 20% or greater in aggressive tumors. Sun et al 54 counted the number of centroblasts within the follicular aggregates and showed a high concordance with the histologic grade.…”

Diagnosis of Lymphoma by Image-Guided Needle Biopsies

“…Our method of grading follicle center cell lymphomas on FNAB (Figures 1 and 2) is based on the method of Young et al 39 However, we divide follicle center cell lymphomas into 3 grades rather than 2. Our grading system is as follows: grade 1, < 5% transformed lymphocytes; grade 2, 5-19% transformed lymphocytes; grade 3, ≥ 20% transformed lymphocytes.…”