Effectiveness of Fine Needle Aspiration and/or Core Needle Biopsy for Subclassifying Follicular Lymphoma and Guiding Initial Treatment Decisions
John K Frederiksen, Richard Burack. University of Rochester Medical Center, Rochester, NY
Background: Subclassification of lymphomas into distinct entities as defined by the WHO is critical for guiding therapeutic decisions. Effective diagnosis and subclassification require a synthesis of data from morphology, flow cytometry, immunohistochemistry, and molecular studies. Excisional biopsy of lymph nodes yields diagnostic information from each of these areas, and therefore is the procedure of choice for diagnosing lymphoma. However, material from fine needle aspiration cytology and core needle biopsies (FNAC/CNB) are increasingly used to diagnose lymphoma. We inquired as to the ability of these approaches to yield both a diagnosis and a subclassification of lymphoma sufficient to initiate therapy.
Design: We surveyed the literature for studies reporting the use of FNAC/CNB for the diagnosis of lymphoma, and in particular for diagnosing subclassifications of non-Hodgkin lymphoma. Inclusion criteria were as follows: (1) studies including FNAC and/or CNB with any of the ancillary techniques done on suspected lymphoma cases; and (2) studies providing lymphoma subtype-level diagnosis for the diagnosed lymphomas, or a rate at which the methods failed to provide a diagnosis sufficient to initiate therapy. Case studies, review articles, and letters were excluded.
Results: Thirty-three studies published since 1986 were identified that fulfilled the inclusion criteria. Based on all 33 studies, subclassification of follicular lymphomas sufficient to guide initial therapy could be obtained in a median of 16% of cases. Seventeen studies had case selection criteria stated as “all suspected lymphoma cases” or a similar characterization, while the remainder dealt only with cases for which the specimens showed a diagnosis of lymphoma. For these 17 “intent to diagnose” studies, the median fraction of non-actionable diagnoses for FNAC and CNB, alone or in combination, was 31%. Most of the diagnoses reported in the case series were “large B cell” lymphomas, with T cell lymphomas significantly underrepresented when compared with known incidence data. Finally, no study, including those termed “prospective” by the authors, was based on power calculations to indicate that the size of the study was pre-defined, and no study performed both excisional biopsies and FNAC/CNB on sequential, unselected patients.
Conclusions: Despite the ever-increasing availability of molecular and flow cytometric methods over the last quarter century, we do not detect a discernible decrease in the rate of non-actionable lymphoma diagnoses obtained by FNAC and/or CNB.
Monday, March 19, 2012 1:00 PM
Poster Session II # 215, Monday Afternoon