Comparison of Fine Needle Aspiration and Needle Core Biopsies in the Diagnosis of T-Cell Lymphomas.
Anna D Castiglione Richmond, Ruth L Katz. The University of Texas MD Anderson Cancer Center, Houston
Background: T-cell lymphomas (TL) may be difficult to diagnose and subclassify on small biopsies. TL diagnosed by Fine Needle Aspiration (FNA) were reviewed, along with concurrently obtained lymph node core biopsies, to determine if FNA is a good diagnostic modality for diagnosing TL.
Design: Ninety-eight cases of TL, diagnosed at MD Anderson Cancer Center, were reviewed for a five year period, from 2005 to 2010. A subset of 23 cases were diagnosed by FNA and concurrent core biopsy, in conjunction with immunophenotyping by flow cytometry (FCM) and slide based immunohistochemistry (IHC). FCM results from FNA were incorporated into both core and FNA reports. The FNA results and core biopsy diagnoses for the 23 cases of TL were categorized by subtype, based on the WHO classification. The diagnosis by the two techniques was compared.
Results: All 23 concurrent cases (FNA and biopsy) showed a malignant T-cell lesion, however only 12 cases had concordant diagnoses and subclassification. These cases included 5 cases of Peripheral T-cell lymphoma-NOS (PTCL), 2 cases of PTCL-Lennert's variant, 2 cases of Anaplastic large cell lymphoma (ALCL) and the 3 cases of Mycosis fungoides (MF).
There were a total of 11 discordant cases. The 3 cases of CD 30 positive transformed PTCL were not identified by FNA but the diagnoses were rendered on the concordant lymph node core biopsy. The diagnosis of Angioimmunoblastic T-cell lymphoma (AILD) (5 cases) was also made by histologic analysis of the lymph node cores. Two cases of MF in transformation and the Extranodal NK T-Lymphoma were not able to be subclassified by FNA but were, subsequently, categorized on the concurrent lymph node core biopsy.
Conclusions: FNA is a good diagnostic tool, when compared to concurrent lymph node core biopsy, for PTCL, PTCL- Lennert's variant, ALCL and MF since there was complete concordance among the FNA diagnosis and lymph node core biopsy results. FNA aspiration failed to identify the cases of MF in transformation, CD 30 positive transformed PTCL and Extranodal NK T-Lymphoma. The diagnosis of AILD is also better rendered on the lymph node core biopsy, as opposed to FNA alone, due to the importance of the architectural features in this category of T-cell lymphoma. Use of immunophenotyping and morphology by FNA can result in a diagnosis of TL, however core biopsy was required for a more specific subtype.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 86, Wednesday Afternoon