Fine Needle Aspiration Biopsy of Hodgkin Lymphoma: The UCSF Experience
Nhu Thuy Can, Annemieke van Zante. University of Chicago, Chicago, IL; University of California, San Francisco, CA
Background: Fine needle aspiration biopsy (FNAB) is the initial diagnostic procedure of choice for unexplained lymphadenopathy. FNAB, in combination with flow cytometry and other adjunct testing modalities, is highly reliable in the detection of mature B-cell lymphomas and mestastatic neoplasms. The accuracy of FNAB for the diagnosis of Hodgkin lymphoma (HL) is reported to be approximately 33-92%; thus, the role of FNAB in primary diagnosis and management of patients with HL remains controversial. Our study reviews the performance of FNAB in the diagnosis of HL at UCSF over the past 15 years.
Design: The UCSF Department of Pathology database was searched for all lymph node excisional biopsy specimens where a diagnosis of HL was rendered between 1998 and 2012. All cases where FNAB of the same node or node group was performed preoperatively were selected for diagnostic correlation. A separate search of all lymph node FNAB specimens with a diagnosis of HL was performed. Data regarding the use of confirmatory immunohistochemical stains and clinical followup were obtained. The diagnostic sensitivity and false negative rate were calculated based on the assembled data.
Results: Twenty-five patients were identified who had a lymph node excisional biopsy specimen with a diagnosis of HL with a preceding FNAB of the same node or node group. Definitive diagnosis of HL was rendered on the preceding FNAB specimen in 11 cases. FNAB samples were insufficient for diagnosis in 4 cases. Using surgical biopsy as the "gold standard" for diagnosis of Hodgkin lymphoma, FNAB has a sensitivity of approximately 85% and a false negative rate of 8%. An additional 15 patients received a definitive diagnosis of HL on FNAB and went directly to therapy, avoiding surgical biopsy. If these patients are included in this calculation, the sensitivity increases to 93% and the false negative rate falls to 7%. False negative cases include one CT-guided FNAB with concurrent core biopsy and one palpation-guided FNAB.
Conclusions: Despite the relatively small number of cases for which a primary diagnosis of HL is rendered, primary diagnosis of HL by FNAB is highly reliable at our institution. No false positive diagnoses were identified over a 15 year time interval. The sensitivity of this test is >85% and diagnosis is frequently supported by appropriate immunohistochemical stains.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 64, Tuesday Afternoon