Combined Core Needle Biopsy, Fine Needle Aspiration and Flow Cytometry for the Diagnosis of Lymphoma
C Amador-Ortiz, A Hassan, J Frater, TD Nguyen, F Kreisel. Washington University, St Louis, MO
Background: Core needle biopsy (CNB) and fine needle aspiration (FNA) in combination with flow cytometry are increasingly being used for the diagnosis of lymphoma. Their advantages compared to excisional biopsy include lower cost, simpler technique and fewer complications; inadequate or insufficient material sampling is nevertheless a concern. The present study evaluates the utility and accuracy of combined CNB and FNA with and without flow cytometry in the diagnosis of lymphoma.
Design: Two hundred and sixty three patients (mean age 55 years, range 19-95) who underwent CNB for suspected lymphoma, were retrospectively identified from our pathology database for the period of 2003 to 2009. Biopsies were obtained from superficial (axilla, neck, and groin) and deep sites (thorax, abdomen, retroperitoneum, and pelvis) in 172 (65%) and 87 cases (33%), respectively. Concomitant FNA was performed in 194 cases (74%) and of these 64% had successful flow cytometry. Diagnosis was derived from the combined information of available CNB, FNA and/or flow cytometry. In 57 cases, subsequent results from excisional biopsy were available for comparison.
Results: A diagnosis using the combination of CNB, FNA and/or flow cytometry was established in 219 cases (83%). In 176 patients further pathologic subclassification was possible (see table). A diagnosis could not be established in 44 patients (17%): 28 cases revealed suspicious but not conclusive findings for lymphoma and in 16 cases the specimen was too small for meaningful analysis. When a diagnosis could be established, the combination of CNB, FNA, and/or flow cytometry had a concordance of 100% with results of subsequent excisional biopsy as the reference. Cases in which a diagnosis could be made had a significantly higher proportion of flow cytometry performed, compared to those in which a diagnosis could not be established (χ², p<0.01). No difference was found regarding biopsy location.
|Non Hodgkin's B-cell lymphoma|
|Diffuse large B-cell||35||20|
|Other low grade B-cell||15||8|
|Reactive / benign||63||36|