Non-Hodgkin Lymphoma Diagnosis by Concurrent Fine-Needle Aspiration and Flow Cytometry: 123 Cases with Histologic Follow-Up.
Oname O Burlingame, Kesse O Kesse, David W Kindelberger, Edmund S Cibas, David M Dorfman. Brigham and Women's Hospital and Harvard Medical School, Boston, MA
Background: Non-Hodgkin Lymphoma (NHL) diagnosis has traditionally been based on histopathologic analysis. With the increasing emphasis on non-invasive procedures in medicine, fine-needle aspiration (FNA) has become a common method of tissue acquisition. Despite studies suggesting that NHL can be accurately diagnosed using FNA in conjunction with flow cytometry (FC), its use is not completely accepted by either the hematopathology or hematology/oncology communities. Prior studies have suffered from limited size, scope, or lack of histologic correlation. The purpose of this study was to assess the use of FNA with FC alone for NHL diagnosis using a large number of cases, all with histologic correlation.
Design: 123 FNA biopsies from 118 patients were analyzed. Each FNA had histologic follow-up and a diagnosis of NHL on the FNA and/or histology. Each FNA was assessed on-site for adequacy and a portion triaged for 6-color FC analysis for lymphoma using standard methods. Diagnosis of the FNA was rendered by a cytopathologist who had knowledge of the FC results. FC and histologic diagnoses were rendered by a separate group of pathologists. Accuracy of the FNA diagnosis was established by comparison to the histologic diagnosis and correlated with the body part biopsied, imaging method, and lymphoma classification.
Results: Of the 123 FNA biopsies, 88 (71%) matched the histologic diagnosis. Image-guided biopsies were more accurate (74%) than those performed on palpable lesions (57%). Imaging method had no effect on accuracy, but on-site adequacy assessment did correlate with accuracy (74% accuracy in adequate biopsies verses 64% in inadequate biopsies). Of the common FNA sites, bone and retroperitoneum had the highest accuracy (83% and 76%, respectively), while abdomen and neck were lower (68% and 55%, respectively). Of the common lymphoma classifications, plasma cell neoplasms and follicular lymphoma had the highest accuracy (83% and 77%, respectively); and B cell lymphoproliferative disorder, NOS, and diffuse large B cell lymphoma had the lowest (70% and 57%, respectively). Diagnosis of recurrence verses primary NHL had no effect on accuracy. Timing of the FNA diagnosis in relationship to the histology diagnosis had no effect on accuracy.
Conclusions: FNA with concurrent FC is an accurate method for NHL diagnosis. Image-guidance and on-site adequacy assessment improves accuracy.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 85, Wednesday Afternoon