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Di Lorenzo S, Milia WR, Corradino B, Rinaldi G, Rao M, Cordova A. Radioguided Occult Lesion Localization Technique for Biopsy of Nonpalpable Subcutaneous Lesions in Suspected Metastatic Melanoma. Plast Reconstr Surg 2024; 154:619e-624e. [PMID: 37734112 DOI: 10.1097/prs.0000000000011071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
SUMMARY In patients with a history of melanoma, the risk of recurrence depends on the stage at diagnosis. Patients who present with more advanced disease are more likely to experience recurrence; patients with less advanced disease at presentation have slower progression and lower likelihood of recurrence. The aim of this study was to evaluate the use of a minimally invasive and targeted technique as a diagnostic and therapeutic tool for the excision of nonpalpable lesions suspected to be melanoma metastases. The authors evaluated 21 patients with stage IIB, IIC, or III melanoma and subcutaneous nonpalpable lesions with a high risk of malignancy on positron emission tomography/computed tomography scan during oncologic follow-up. To guide biopsy, the authors used the radioguided occult lesion localization technique, using intralesional injection of technetium-99m albumin macroaggregates the day before surgery. During surgery, a handheld gamma probe was used to locate the lesions. Surgical localization of radiolabeled lesions was achieved in all cases. Relapsed melanoma was histologically confirmed in 13 patients. This technique proved to be a simple, safe, and effective method to detect and biopsy nonpalpable or difficult-to-locate lesions in suspected metastatic melanoma. The main advantage was disease restaging (eg, from stage II to III), allowing patients to access adjuvant therapies not approved as early-stage melanoma treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | | | | | - Gaetana Rinaldi
- Medical Oncology, Department of Surgical, Oncological, and Oral Sciences
| | - Marco Rao
- Interventional Radiology, University of Palermo, AOUP Paolo Giaccone
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Nga ME. Pitfalls in Lymph Node Fine Needle Aspiration Cytology. Acta Cytol 2023; 68:260-280. [PMID: 38118434 PMCID: PMC11305520 DOI: 10.1159/000535906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an accurate, minimally invasive, and cost-effective biopsy method for enlarged lymph nodes. While the role of lymph node FNAC in the diagnosis of infectious or reactive conditions and metastatic malignancy is unquestioned, differing views still exist on its role in the diagnosis of lymphoma. Nevertheless, regardless of the practice setting, pitfalls and potential for error exist, and it is incumbent upon the pathologist to be aware of these pitfalls, as this is the first line of defence against errors. SUMMARY This discussion will focus on potential interpretational errors, specifically highlighting scenarios leading to false-negative and false-positive diagnosis and errors in tumour classification, with an emphasis on cytomorphology. Potential entities that may fly below the radar of the pathologist - so-called off-radar entities - are also discussed, as a reminder to consider broad differentials in cases with unusual morphologic features. Some reasons for false-negative diagnoses include low-grade lymphomas that mimic a mixed, polymorphous reactive lymphoid population or aspirates with a paucity of lesional cells, through either sampling error or the intrinsic nature of the entity, e.g., nodular lymphocyte predominant Hodgkin lymphoma. Some of the potential causes of false-positive diagnoses that are discussed include viral-associated lymphadenopathy, Kikuchi-Fujimoto lymphadenitis, or benign adnexal lesions mimicking metastatic malignancy. Errors in tumour classification covered include metastatic carcinoma, sarcoma, melanoma, and lymphoma mimicking each other, and Hodgkin lymphoma and its mimics. Finally, less common entities such as follicular dendritic cell sarcoma and others are briefly mentioned, to remind us of conditions that may slip under our diagnostic radar. KEY MESSAGES A systematic review of diagnostic pitfalls and traps is elucidated here, with some tips to avoid these traps. The triple approach to the diagnostic workup is emphasised, which includes rigorous clinicopathologic correlation, attention to cytomorphology, and judicious application of ancillary tests.
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Affiliation(s)
- Min En Nga
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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3
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Das S, Dey MK, Devireddy R, Gartia MR. Biomarkers in Cancer Detection, Diagnosis, and Prognosis. SENSORS (BASEL, SWITZERLAND) 2023; 24:37. [PMID: 38202898 PMCID: PMC10780704 DOI: 10.3390/s24010037] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
Biomarkers are vital in healthcare as they provide valuable insights into disease diagnosis, prognosis, treatment response, and personalized medicine. They serve as objective indicators, enabling early detection and intervention, leading to improved patient outcomes and reduced costs. Biomarkers also guide treatment decisions by predicting disease outcomes and facilitating individualized treatment plans. They play a role in monitoring disease progression, adjusting treatments, and detecting early signs of recurrence. Furthermore, biomarkers enhance drug development and clinical trials by identifying suitable patients and accelerating the approval process. In this review paper, we described a variety of biomarkers applicable for cancer detection and diagnosis, such as imaging-based diagnosis (CT, SPECT, MRI, and PET), blood-based biomarkers (proteins, genes, mRNA, and peptides), cell imaging-based diagnosis (needle biopsy and CTC), tissue imaging-based diagnosis (IHC), and genetic-based biomarkers (RNAseq, scRNAseq, and spatial transcriptomics).
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Affiliation(s)
| | | | | | - Manas Ranjan Gartia
- Department of Mechanical and Industrial Engineering, Louisiana State University, Baton Rouge, LA 70803, USA; (S.D.); (M.K.D.); (R.D.)
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Ren Y, Shi Y, Zhou Z, Yang D, Xie J, Zhang Z, Wang J. Ultrasonographic and cytological characterization of ultrasound-guided fine-needle aspiration cytology of cervical lymph nodes for false-negative and false-positive diagnosis. Eur Arch Otorhinolaryngol 2022; 280:2463-2470. [PMID: 36571612 DOI: 10.1007/s00405-022-07802-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The primary goal of this study was to examine the ultrasound and cytological characteristics of inconsistent cases (false negatives and false positives)of ultrasound-guided fine-needle aspiration cytology (US-FNAC) of cervical lymph nodes, to investigate factors influencing the diagnostic accuracy of fine-needle aspiration, and to improve diagnostic efficiency. METHODS The results of US and FNAC of cervical lymph nodes in 562 cases treated at our institution from February 2019 to June 2021 were retrospectively analyzed. FNAC cytology results were compared with the final diagnostic results (242 surgical resections/core-needle biopsy, 320 cases followed up for more than 1 year), and the final diagnostic results were taken as the gold standard, and the ultrasound features and clinicopathology-related features were systematically retrospectively analyzed in cases of inconsistency. RESULTS The overall diagnostic accuracy of US-FNAC for cervical lymph nodes was 94.9%, with a false-negative rate of 6.7% and a false-positive rate of 3.8%. Analyzing the cases, sampling error due to factors associated with ultrasound features, such as larger, more numerous nodes, non-solid, hypoechoic, inhomogeneous, and increased vascularity are the main causes of false-negative diagnosis, while smaller nodules, overlapping cytologic patterns, and overinterpretation by pathologists are associated with false-positive FNAC results. CONCLUSIONS Proper interpretation of cytomorphologic and ultrasound features can improve diagnostic accuracy, and diagnostic misdiagnosis should be carefully observed, the identification of both features should be enhanced to reduce interpretation errors and sampling errors and to reduce the rate of misdiagnosis and missed diagnoses in fine needle aspiration of lymph nodes.
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Affiliation(s)
- Yiqun Ren
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Yucong Shi
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Zubang Zhou
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China.
| | - Daxiong Yang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jinhui Xie
- Department of Ultrasound, Gansu Provincial Hospital, No. 204 West Dong-Gang Road, Lanzhou, Gan su, 730000, China
| | - Zhi Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Jiao Wang
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
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5
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Taye E, Ali MM, Toma A, Teklehaimanot A. Comparison of Fine Needle Aspiration Cytology and Histopathology in the diagnosis of lymph node pathologies at health facilities located in Hawassa: A 5-year retrospective study. SAGE Open Med 2022; 10:20503121221138324. [PMID: 36568339 PMCID: PMC9768821 DOI: 10.1177/20503121221138324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the performance of Fine Needle Aspiration Cytology in the diagnosis of lymph node pathologies in comparison with Histopathologic examination. Methods A retrospective health facility-based cross-sectional study was carried out at health facilities located in Hawassa city among 101 patients who had both Fine Needle Aspiration Cytology and Histopathologic examination on the same site from 13 September 2016 to 30 August 2021. Background data were collected using a structured questionnaire and analyzed by SPSS version 20. Results A total of 3892 patients had Fine Needle Aspiration Cytology for lymphadenopathies within a specified 5-year span, out of which 101 cases had both Fine Needle Aspiration Cytology and Histopathologic examination. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of fine needle aspiration cytology for the diagnosis of lymphoma were 88.2%, 92%, 91.8%, 88.5%, and 90.1%, respectively. Conclusions Fine Needle Aspiration Cytology can be recommended for clinically significant lymphadenopathy as a first-line diagnostic test since it is fast, safe, cost-effective, reasonably sensitive, and specific with significant positive and negative predictive values and diagnostic accuracy.
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Affiliation(s)
- Endeshaw Taye
- Department of Pathology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alemeyehu Toma
- School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alemwosen Teklehaimanot
- Department of Pathology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia,Alemwosen Teklehaimanot, Department of Pathology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
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Abbott M, Jiang L(J, Youssef B, Siddiqi A, Nassar A. Reliability of lymphoma diagnosis using combined cytologic preparations and core needle biopsy: A single-center analysis. Cytojournal 2022. [DOI: 10.25259/cytojournal_22_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives:
The diagnosis of lymphoma on cytologic preparations and core needle biopsies (CNBs) is often challenging due to limited material that precludes additional ancillary testing for accurate classification. We describe our institutional experience with patients who ultimately received a diagnosis of lymphoma using cytologic preparations and CNB material along with additional ancillary testing.
Material and Methods:
All patients whose cytology material (fluids, cytologic smears, and cell block) and CNB resulted in a diagnosis of lymphoma, atypical lymphoid population, or suspicious for lymphoma were retrieved. Diagnoses of lymphoma followed the established nomenclatures of the World Health Organization (WHO). For all cases, the ancillary test profiles were captured and summarized.
Results:
Of 389 cases identified, 17 (4.4%) were diagnosed as atypical lymphoid cells and 31 (7.9%) were suspicious for lymphoma resulting in an indeterminate rate of 12.3%. The rest of the malignant cases (341; 87.7%) were classified using 2017 WHO lymphoid classification system. Six low-grade and 26 high-grade B-cell lymphomas were not further classified because of limited tissue. B-cell lymphomas were the largest category (73.0%): Primarily diffuse large B-cell lymphoma (21.4%), followed by follicular lymphoma (17.5%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (10.9%). A total of 140 cases (36.0%) had flow cytometry results, but 30 specimens (21.4%) were insufficient. Cytogenetic and molecular studies were performed for 78 cases (20.0%).
Conclusion:
Full classification of lymphomas is possible with combined cytologic preparations and CNB material and it is an attractive first sampling modality in the diagnostic process for this disease group.
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Affiliation(s)
- Marcia Abbott
- Department of Pathology and Labortaory Medicine, Alberta Precision Labs, Red Deer, Alberta, Canada,
| | - Liuyan (Jennifer) Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida, United States,
| | - Bahaaeldin Youssef
- Department of Pathology and Laboratory Medicine, East Tennesse State University, Johnson, Tennessee, United States,
| | - Ahsan Siddiqi
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida, United States,
| | - Aziza Nassar
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida, United States,
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Zadeh SL, Balassanian R, Cheung MC, Falchi L, Hasserjian R, Lin O, Long SR, Ly A, Menke JR, Mou E, Natkunam Y, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Gratzinger D. Global Cytopathology-Hematopathology Practice Trends. Am J Clin Pathol 2022; 157:196-201. [PMID: 34508545 DOI: 10.1093/ajcp/aqab111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Small-volume biopsy-fine-needle aspiration biopsy (FNAB) with or without core biopsy-is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out. METHODS This study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated. RESULTS Most respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma. CONCLUSIONS This survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.
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Affiliation(s)
- Sara L Zadeh
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Ronald Balassanian
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Matthew C Cheung
- Department of Medicine, Division of Hematology/Oncology, University of Toronto, Toronto, Canada
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Eric Mou
- College of Medicine, Division of Hematology, University of Iowa, Iowa City, IA, USA
| | | | - Roberto Ruiz-Cordero
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | - Linlin Wang
- Department of Laboratory Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA
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8
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Garg S, Rohilla M, Srinivasan R, Bal A, Das A, Dey P, Gupta N, Gupta P, Rajwanshi A. Fine-Needle Aspiration Diagnosis of Lymphoma Based on Cytomorphology Alone: How Accurate is it? - A Cyto-Histopathology Correlative Study. J Cytol 2021; 38:164-170. [PMID: 34703094 PMCID: PMC8489699 DOI: 10.4103/joc.joc_217_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/26/2021] [Accepted: 08/18/2021] [Indexed: 12/29/2022] Open
Abstract
Context: Fine-needle aspiration cytology (FNAC) is a rapid and accurate first-line diagnostic modality in lymphadenopathy. Aims: To determine the utility of FNAC for the diagnosis of lymphoma and highlight the various pitfalls in morphological interpretation. Settings and Design: This was a retrospective study of 3 years duration in which cytology diagnosis was compared with the follow-up histopathology diagnosis wherever available. Results: A cytodiagnosis of lymphoma was made in a total of 868 cases (2.8%) out of nearly 33,000 FNAC performed during the study period; 556 (64.1%) cases were diagnosed as non-Hodgkin lymphoma (NHL), 198 (22.8%) as Hodgkin lymphoma (HL), and in 114 (13.1%) cases, a cytological diagnosis of lymphoma without further categorization was given. Histopathological reports were available in 348 cases, with an overall concordance rate of 93.1% (324), which was slightly higher in the HL cases (95.8%) as compared to NHL (91.7%). Twenty-four cases (6.9%) showed discordant cytological diagnosis with subsequent histopathology. The main reasons for the erroneous diagnosis were the over-interpretation of the germinal center cells as atypical lymphoid cells, over-interpretation of immunoblasts with prominent nucleoli as Hodgkin cells, and sheets of monomorphic lymphoid cells interpreted as low-grade lymphoma. Conclusion: Cytomorphology alone can make a correct basic diagnosis of lymphoma with a high degree of accuracy. The errors in interpretation can be further reduced by careful attention to the diagnostic pitfalls and common differential diagnoses.
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Affiliation(s)
- Sumit Garg
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wang H, Hariharan VS, Sarma S. Diagnostic accuracy of fine-needle aspiration cytology for lymphoma: A systematic review and meta-analysis. Diagn Cytopathol 2021; 49:975-986. [PMID: 34004059 DOI: 10.1002/dc.24800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) has become one of the most useful modalities for diagnosis and staging of lymphoma. However, diagnostic accuracy of this technique has been reported with varying results across several studies around the world. Hence, this meta-analysis was done to assess the accuracy of FNAC for lymphoma diagnosis. METHODS We conducted a systematic search for all studies reporting the diagnostic accuracy of FNAC for lymphoma in the databases of PubMed Central, MEDLINE, EMBASE, MEDLINE, SCOPUS and Cochrane library from inception till January 2021. Meta-analysis was performed using STATA software "midas" package. RESULTS Forty-seven studies with 7268 patients were included. The pooled sensitivity and specificity of FNAC for diagnosing lymphoma were 93% (95% CI, 90%-95%) and 97% (95% CI, 95%-98%), respectively. Likelihood ratio positive was 33.5 (95% CI, 18.5-60.7) and likelihood ratio negative was 0.07 (0.05-0.11) making the technique to occupy the left upper quadrant in LR scattergram indicating that FNAC can be used for confirmation and exclusion. There was significant heterogeneity with significant chi-square test and I2 statistic >75%. There was significant publication bias as per Deek's test and funnel plot. CONCLUSION To summarize, our study found that FNAC has a vital role as a diagnostic tool for lymphoma with higher sensitivity and specificity. Further studies assessing the accuracy of FNAC on specific types of lymphoma is required.
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Affiliation(s)
- Huan Wang
- Department of Hematology Oncology, Taizhou People's Hospital, Taizhou, Jiangsu Province, 225300, China
| | | | - Susmita Sarma
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
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Shah A, Ross C, Sur M. An approach to small lymph node biopsies: pearls and pitfalls of reporting in the real world. J Am Soc Cytopathol 2021; 10:328-337. [PMID: 33812794 DOI: 10.1016/j.jasc.2020.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/20/2020] [Accepted: 12/24/2020] [Indexed: 12/17/2022]
Abstract
Recent advances in interventional radiology have resulted in the utilization of small lymph node biopsies, including fine-needle aspiration (FNA) and core needle biopsy (CNB) as an initial diagnostic tool in hematopathology. A major challenge to the utilization of FNA and CNB is the limited-to-scant tissue often available. We propose delegation of the task of handling biopsy specimens to the laboratory staff by the biopsy operators, in order to optimize the utilization of the specimen. Furthermore, in order to effectively diagnose hematolymphoid neoplasms a variety of ancillary tests including immunohistochemistry, flow cytometry, molecular analysis, florescence in situ hybridization (FISH) are necessary. We propose morphological evaluation coupled with careful utilization of ancillary studies along with clinical correlation to approach the correct diagnosis. Our morphological assessment considers the types of proliferating cell population: mainly small cells, sheets of large cells, or scattered large cells among small cells. This is followed by employment of the corresponding immunopanel to assess the differential diagnosis in each of the three categories. We also elaborate on the importance for pathologists to become proficient in understanding the limitations of small tissue biopsies as well as the differences in interpretation, and wording their reports to help clinicians and direct them to further investigate and/or to re-biopsy when necessary.
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Affiliation(s)
- Ahmed Shah
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Catherine Ross
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
| | - Monalisa Sur
- Division of Anatomical Pathology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON.
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11
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Chi PD, Liu YJ, Huang YH, Mao MJ, Wang Y, Li ZM, Li J. Rinsing sampling of core needle biopsy for flow cytometric analysis: A favorable method for lymphoma diagnosis. Cancer Med 2020; 9:9336-9345. [PMID: 33070470 PMCID: PMC7774716 DOI: 10.1002/cam4.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/08/2020] [Accepted: 09/24/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Conventional protocols utilize core needle biopsy (CNB) or fine needle aspiration (FNA) to produce cell suspension for flow cytometry (FCM) is a diagnostic challenge for lymphoid malignancies. We aim to develop an alternative CNB rinsing technique (RT) to produce cell suspension for FCM during this mini-invasive procedure of CNB for lymphoma diagnosis. METHODS FNA and CNB specimens from the same lesion of 93 patients with suspected lymphoma were collected under the guidance of B-ultrasound simultaneously. The fresh CNB samples were prepared to cell suspension by RT for FCM immunophenotyping analysis (Group CNB-RT). Then, the CNB tissues after performing the RT process and the fresh FNA tissues were processed by conventional tissue cell suspension (TCS) technique to obtain the cell suspensions (Groups of CNB-TCS & FNA-TCS), respectively, as comparison. The diagnostic efficacies, as well as the concordances of the FCM results with reference to the morphologic diagnoses were compared in these three groups. RESULTS RT could yield sufficient cells for FCM immunophenotyping analysis, though a lower cell numbers compared to TCS technique. The diagnostic concordance was comparable in group CNB-RT (91.1%) to the group CNB-TCS (88.9%) and group FNA-TCS (88.4%) (p = 0.819). The diagnostic sensitivity and specificity of CNB-RT (91.1%; 100%) was not inferior to that of CNB-TCS (88.9%; 100%) and FNA-TCS (88.4%; 98.8%). CONCLUSIONS This study shows the CNB-RT presented non-inferior diagnostic concordance and efficacy as compared to the TCS technique. CNB-RT has the potential to produce cell suspension for FCM immunophenotyping while preserving tissue for lymphoma diagnosis and research.
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Affiliation(s)
- Pei-Dong Chi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yi-Jun Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yu-Hua Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Ming-Jie Mao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Yu Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Internal Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Zhi-Ming Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Internal Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
| | - Jian Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.,Department of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China
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R Infante J, I Rayo J, Serrano J, Jiménez JL, Moreno M, Martínez A, Jiménez P, Cobo A. Application of the ROLL technique as a method of excisional biopsy in oncological pathology. Cir Esp 2020; 99:49-54. [PMID: 32386936 DOI: 10.1016/j.ciresp.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. MATERIAL AND METHODS 33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. RESULTS In 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. CONCLUSION The ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.
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Affiliation(s)
- Jose R Infante
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - Juan I Rayo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Justo Serrano
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Jose Luis Jiménez
- Servicio de Cirugía General, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Manuel Moreno
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Andrés Martínez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Pedro Jiménez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - Amparo Cobo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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13
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Ingersoll KF, Zhao Y, Harrison GP, Li Y, Yang LH, Wang E. Limited Tissue Biopsies and Hematolymphoid Neoplasms. Am J Clin Pathol 2019; 152:782-798. [PMID: 31365922 DOI: 10.1093/ajcp/aqz107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Use of fine-needle aspiration/needle core biopsy (FNA/CNB) in evaluating hematolymphoid processes has been debated. We investigate its applicability in various clinicopathologic settings. METHODS We retrospectively analyzed 152 cases of FNA/CNB. RESULTS Of 152 FNA/CNBs, 124 (81.6%) resulted in diagnoses without excisional biopsies, while 28 required subsequent excisional biopsies. Of these, 43 FNA/CNBs performed for suspected lymphoma relapse demonstrated 95.4% diagnostic rate (41/43), which was significantly better than those without history of lymphoma (77/109, 71%; odds ratio [OR], 8.5; confidence interval, 1.9-37.4). Patients with immunodeficiency also showed a high rate of diagnosis by FNA/CNB (100%). When stratified by types of disease, diffuse large B-cell lymphoma/high-grade B-cell lymphoma demonstrated a higher success rate (92.7%) than small B-cell lymphoma (79.2%), though the difference was not statistically significant (OR, 3.3; P value = .07). A subsequent excisional biopsy was required in 28 cases, 23 of which resulted in diagnoses concordant with the FNA/CNB. Five cases showed diagnostic discordance, reflecting pitfalls of FNA/CNB in unusual cases with complex pathology. CONCLUSIONS FNA/CNB is practical in evaluating most hematolymphoid lesions, with high efficacy in recurrent disease and some primary neoplasms with homogeneous/ aggressive histology, or characteristic immunophenotype.
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Affiliation(s)
| | - Yue Zhao
- Department of Pathology, Duke University Hospital, Durham, NC
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shengyang, China
| | - Grant P Harrison
- Department of Pathology, University of Virginia, Charlottesville
| | - Yang Li
- Department of Pathology, Duke University Hospital, Durham, NC
| | - Lian-He Yang
- Department of Pathology, Duke University Hospital, Durham, NC
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shengyang, China
| | - Endi Wang
- Department of Pathology, Duke University Hospital, Durham, NC
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14
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Guan Q, Wan X, Lu H, Ping B, Li D, Wang L, Zhu Y, Wang Y, Xiang J. Deep convolutional neural network Inception-v3 model for differential diagnosing of lymph node in cytological images: a pilot study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:307. [PMID: 31475177 DOI: 10.21037/atm.2019.06.29] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In this study, we exploited the Inception-v3 deep convolutional neural network (DCNN) model to differentiate cervical lymphadenopathy using cytological images. Methods A dataset of 80 cases was collected through the fine-needle aspiration (FNA) of enlarged cervical lymph nodes, which consisted of 20 cases of reactive lymphoid hyperplasia, 24 cases of non-Hodgkin's lymphoma (NHL), 16 cases of squamous cell carcinoma (SCC), and 20 cases of adenocarcinoma. The images were cropped into fragmented images and divided into a training dataset and a test dataset. Inception-v3 was trained to make differential diagnoses and then tested. The features of misdiagnosed images were further analysed to discover the features that may influence the diagnostic efficiency of such a DCNN. Results A total of 742 original images were derived from the cases, from which a total of 7,934 fragmented images were cropped. The classification accuracies for the original images of reactive lymphoid hyperplasia, NHL, SCC and adenocarcinoma were 88.46%, 80.77%, 89.29% and 100%, respectively. The total accuracy on the test dataset was 89.62%. Three fragmented images of reactive lymphoid hyperplasia and three fragmented images of SCC were misclassified as NHL. Three fragmented images of NHL were misclassified as reactive lymphoid hyperplasia, one was misclassified as SCC, and one was misclassified as adenocarcinoma. Conclusions In summary, after training with a large dataset, the Inception-v3 DCNN model showed great potential in facilitating the diagnosis of cervical lymphadenopathy using cytological images. Analysis of the misdiagnosed cases revealed that NHL was the most challenging cytology type for DCNN to differentiate.
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Affiliation(s)
- Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiaochun Wan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Hongtao Lu
- Depertment of Computer Science and Engineering, Shanghai Jiaotong University, Shanghai 200240, China
| | - Bo Ping
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Duanshu Li
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Li Wang
- Depertment of Computer Science and Engineering, Shanghai Jiaotong University, Shanghai 200240, China
| | - Yongxue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yunjun Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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15
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Jelloul FZ, Navarro M, Navale P, Hagan T, Cocker RS, Das K, Rosen L, Zhang X, Sheikh-Fayyaz S. Diagnosis of Lymphoma Using Fine-Needle Aspiration Biopsy and Core-Needle Biopsy: A Single-Institution Experience. Acta Cytol 2019; 63:198-205. [PMID: 30909285 DOI: 10.1159/000497252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/26/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective is to study the efficacy of fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) in the diagnosis of lymphoma in a single institution. STUDY DESIGN We retrospectively reviewed 635 FNAB/CNB cases performed in our institution to rule out lymphoma during a 4-year period and collected the relevant clinical and pathological information for statistical analysis. RESULTS AND CONCLUSIONS This cohort comprised 275 males and 360 females, with a median age of 57 years. Among the 593 cases with adequate diagnostic materials for lymphoma work-up, 226 were positive for lymphoma, 286 were negative for lymphoma, and 81 were nondiagnostic. Each case had an FNAB, and 191 cases also underwent a CNB. The subclassification rate according to the WHO (2008) was 67% overall, 81% for the FNAB with CNB group, and 40% for the FNAB group. In the FNAB with CNB group, the subclassification rates for cases with and without a history of lymphoma were not significantly different. A definitive diagnosis of lymphoma relied on ancillary studies, but was not affected by location, or the needle gauge of CNB. Follow-up data revealed a high diagnostic accuracy of FNAB with CNB. In conclusion, the use of FNAB and CNB with ancillary studies is effective in providing a definitive diagnosis of lymphoma in our experience at the Northwell Health System.
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Affiliation(s)
- Fatima-Zahra Jelloul
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Maria Navarro
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Pooja Navale
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Tamla Hagan
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Rubina S Cocker
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Lisa Rosen
- The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Xinmin Zhang
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA
| | - Silvat Sheikh-Fayyaz
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA,
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16
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Houcine Y, Romdhane E, Blel A, Ksentini M, Aloui R, Lahiani R, Znaidi N, Ben Salah M, Rammeh S. Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas. J Craniomaxillofac Surg 2018; 46:1117-1120. [PMID: 29779620 DOI: 10.1016/j.jcms.2018.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas. MATERIALS AND METHODS This was a retrospective study carried out over a 6-year period (January 2011 to December 2016) and conducted at the Cytology Unit in our Pathology Department (Charles Nicolle Hospital, Tunisia). The measures of diagnostic accuracy of FNAC in the diagnosis of cervical lymph node lymphomas were calculated taking histopathology as the gold standard. RESULTS A total of 937 FNA samples were obtained from 851 patients. The diagnosis of lymphoma was obtained in 65 cases (6.9%). Cytological diagnoses of lymphoma were as follows: 28 (44%) Hodgkin lymphoma, 17 (25%) high-grade lymphoma, 15 (23%) low-grade lymphoma, and 5 (8%) "suggestive of lymphoma." FNAC of cervical lymph nodes had a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5%. CONCLUSION The present study demonstrated that cytology is capable to detect nodes suspicious for the presence of lymphoma precisely, in terms of low- or high-grade lymphoma, which is a relevant and very achievable first step in the management of patients with cervical lymph node lymphoma.
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Affiliation(s)
- Yoldez Houcine
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Emna Romdhane
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Ahlem Blel
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Meriem Ksentini
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Raoudha Aloui
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Rim Lahiani
- Ear, Nose and Throat Department, (Head of the department: Mamia Ben Salah PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Nadia Znaidi
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Mamia Ben Salah
- Ear, Nose and Throat Department, (Head of the department: Mamia Ben Salah PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Pathology Department, (Head of the department: Soumaya Rammeh PhD), Charles Nicolle Hospital, Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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17
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Patel N, Dawe G, Tung K. Ultrasound-guided percutaneous splenic biopsy using an 18-G core biopsy needle: our experience with 52 cases. Br J Radiol 2015; 88:20150400. [PMID: 26337505 DOI: 10.1259/bjr.20150400] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The spleen is more commonly affected in multiorgan disease, but alternative sites are selected for biopsy owing to perceived haemorrhage risk. If these sites are inaccessible or, less commonly, the spleen is the only disease site, then splenic biopsy is considered, with most studies using a 20- to 22-G needle. The primary aim of biopsy is to exclude underlying malignancy or to obtain histological analysis in known malignancy, usually lymphoma, when reclassification is required for therapy. We present, to our knowledge, the largest series of 18-G ultrasound-guided splenic core needle biopsy assessing diagnostic and complication rates. METHODS All ultrasound-guided splenic biopsy cases from May 1990 to May 2015 were identified on the radiology information system. Histological diagnosis and complications were identified from laboratory reports, case notes and discharge summaries to assess diagnostic positive and complication rates. Haemorrhages requiring transfusion, embolization or splenectomy, pneumothorax, other significant intra-abdominal injury or death are classified as major complications, whilst conservative haemorrhage management is considered a minor complication. RESULTS A total of 52 splenic biopsies were performed in 47 patients. A positive diagnostic yield for all biopsies was 90.4%. The major and minor complication rates were 0% and 1.9% (1/52), respectively. CONCLUSION Ultrasound-guided 18-G splenic biopsy is a safe and accurate procedure with no added risk of complications when compared with smaller needles or biopsy of other abdominal organs. ADVANCES IN KNOWLEDGE This is the largest case series of ultrasound-guided splenic biopsy with an 18-G needle, and our experience confirms a high diagnostic yield and a complication rate which compares favourably with the biopsy of other abdominal organs.
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Affiliation(s)
- Nirav Patel
- Department of Radiology, Southampton General Hospital, Southampton, UK
| | - Gemma Dawe
- Department of Radiology, Southampton General Hospital, Southampton, UK
| | - Ken Tung
- Department of Radiology, Southampton General Hospital, Southampton, UK
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18
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Infante J, Rayo J, Serrano J, Domínguez M, García L, Durán C, Moreno M. Clinical application of ROLL technique in non-breast diseases. Complementary use after PET-CT study. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Caraway NP. Evolving role of FNA biopsy in diagnosing lymphoma: Past, present, and future. Cancer Cytopathol 2015; 123:389-93. [DOI: 10.1002/cncy.21551] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Nancy P. Caraway
- Section of Cytopathology; Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
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20
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Frederiksen JK, Sharma M, Casulo C, Burack WR. Systematic review of the effectiveness of fine-needle aspiration and/or core needle biopsy for subclassifying lymphoma. Arch Pathol Lab Med 2015; 139:245-51. [PMID: 25611108 DOI: 10.5858/arpa.2013-0674-ra] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The World Health Organization system for lymphoma classification relies on histologic findings from excisional biopsies. In contradistinction to expert guidelines, practitioners increasingly rely on fine-needle aspiration cytology and core needle biopsies rather than excisional biopsies to diagnose lymphomas. OBJECTIVE To determine a rate at which fine-needle aspiration cytology and core needle biopsies, combined with flow cytometry and/or genetic techniques, can provide a diagnosis sufficient for optimal medical management of lymphoma. DATA SOURCES The English-language literature on fine-needle aspiration cytology and core needle biopsies for lymphoma was reviewed to identify studies that provided interpretations of all specimens regardless of whether these were deemed diagnostic. CONCLUSIONS Forty-two studies (1989-2012) specified the lymphoma subtypes for each diagnosis or indicated a rate at which the methods failed to provide a diagnosis. The median rate at which fine-needle aspiration cytology and core needle biopsies yielded a subtype-specific diagnosis of lymphoma was 74%. Strictly adhering to expert guidelines, which state that follicular lymphoma cannot be graded by these techniques, decreased the diagnostic yield further to 66%. Thus, 25% to 35% of fine-needle aspirates and/or core biopsies of nodes must be followed by an excisional lymph node biopsy to fully classify lymphoma.
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Affiliation(s)
- John K Frederiksen
- From the Department of Pathology and Laboratory Medicine (Drs Frederiksen, Sharma, and Burack) and the Division of Hematology and Oncology, Department of Medicine (Dr Casulo), University of Rochester Medical Center, Rochester, New York. Dr Frederiksen is now with the Department of Pathology, University of Michigan, Ann Arbor
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21
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Jeng Tyng C, Matushita JPK, Bitencourt AGV, Neves FBCS, Amoedo MK, Barbosa PNV, Chojniak R. Uncommon primary tumors of the orbit diagnosed by computed tomography-guided core needle biopsy: report of two cases. Radiol Bras 2015; 47:380-3. [PMID: 25741122 PMCID: PMC4341380 DOI: 10.1590/0100-3984.2013.1888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/17/2014] [Indexed: 02/08/2023] Open
Abstract
Computed tomography-guided percutaneous biopsy is a safe and effective alternative
method for evaluating selected intra-orbital lesions where the preoperative diagnosis
is important for the therapeutic planning. The authors describe two cases of patients
with uncommon primary orbital tumors whose diagnosis was obtained by means of
computed tomography-guided core needle biopsy, with emphasis on the technical aspects
of the procedure.
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Affiliation(s)
- Chiang Jeng Tyng
- Master, Titular Physician and Responsible for the Unit of Percutaneous Intervention, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | | | | | - Paula Nicole Vieira Barbosa
- Master, Titular Physician and Responsible for the Unit of Computed Tomography, Imaging Department at A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rubens Chojniak
- PhD, Titular Physician and Director, Department of Imaging, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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22
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Jarmusch AK, Kerian KS, Pirro V, Peat T, Thompson CA, Ramos-Vara JA, Childress MO, Cooks RG. Characteristic lipid profiles of canine non-Hodgkin's lymphoma from surgical biopsy tissue sections and fine needle aspirate smears by desorption electrospray ionization – mass spectrometry. Analyst 2015; 140:6321-9. [DOI: 10.1039/c5an00825e] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Exploring lipid information characteristic of non-Hodgkin's lymphoma using DESI – mass spectrometry.
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Affiliation(s)
- Alan K. Jarmusch
- Department of Chemistry and Center for Analytical Instrumentation Development
- Purdue University
- 560 Oval Drive
- USA
| | - Kevin S. Kerian
- Department of Chemistry and Center for Analytical Instrumentation Development
- Purdue University
- 560 Oval Drive
- USA
| | - Valentina Pirro
- Department of Chemistry and Center for Analytical Instrumentation Development
- Purdue University
- 560 Oval Drive
- USA
| | - Tyler Peat
- Department of Comparative Pathobiology
- College of Veterinary Medicine
- Purdue University
- West Lafayette
- USA
| | - Craig A. Thompson
- Department of Comparative Pathobiology
- College of Veterinary Medicine
- Purdue University
- West Lafayette
- USA
| | - José A. Ramos-Vara
- Department of Comparative Pathobiology
- College of Veterinary Medicine
- Purdue University
- West Lafayette
- USA
| | - Michael O. Childress
- Department of Veterinary Clinical Sciences
- College of Veterinary Medicine
- Purdue University
- West Lafayette
- USA
| | - R. Graham Cooks
- Department of Chemistry and Center for Analytical Instrumentation Development
- Purdue University
- 560 Oval Drive
- USA
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23
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Infante JR, Rayo JI, Serrano J, Domínguez ML, García L, Durán C, Moreno M. [Clinical application of ROLL technique in non-breast diseases. Complementary use after PET-CT study]. Rev Esp Med Nucl Imagen Mol 2014; 34:162-6. [PMID: 25304844 DOI: 10.1016/j.remn.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/07/2014] [Accepted: 08/10/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of ROLL technique (Radioguided Occult Lesion Localization) as a verification method of suspicious lesions not related to breast disease found in PET-CT studies. MATERIAL AND METHODS We retrospectively evaluated 9 patients diagnosed of cancer or with suspected tumor disease who showed hypermetabolic lymph nodes in (18)F-FDG PET-CT. Subjects underwent diagnostic testing for evaluation of treatment response in lymphoma (3), suspected recurrence in other tumors (3) or biopsy guide (3). The study group consisted of 4 women and 5 men, age range 25-72 years. ROLL technique was performed in surgically accessible lesions (supraclavicular region, lateral cervical, axillary and inguinal) with an intralesional injection of (99m)Tc-albumin macroaggregates guided by ultrasound the day before surgery. A scintigraphic study confirmed the focal tracer deposit and absence of skin contamination. During surgery, a gamma probe and portable gammacamera were used to locate lymph nodes. RESULTS Surgical localization of radiolabeled lymph nodes was achieved in all cases with minimally invasive surgery and few postoperative complications. Histological study resulted in five tumor involvement (3 lymphoma, 1 germ cell tumor and 1 neuroendocrine carcinoma) and confirmed the existence of four false-positives in PET-CT study (1 sarcoidosis and 3 reactive follicular hyperplasia). CONCLUSION The ROLL technique proved to be a useful and relatively simple method for the study of no breast lesions suspicious of malignancy in PET-CT study.
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Affiliation(s)
- J R Infante
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - J I Rayo
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - J Serrano
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - M L Domínguez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - L García
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - C Durán
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - M Moreno
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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Pinheiro D, Chang YM, Bryant H, Szladovits B, Dalessandri T, Davison LJ, Yallop E, Mills E, Leo C, Lara A, Stell A, Polton G, Garden OA. Dissecting the regulatory microenvironment of a large animal model of non-Hodgkin lymphoma: evidence of a negative prognostic impact of FOXP3+ T cells in canine B cell lymphoma. PLoS One 2014; 9:e105027. [PMID: 25119018 PMCID: PMC4132014 DOI: 10.1371/journal.pone.0105027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 07/19/2014] [Indexed: 02/06/2023] Open
Abstract
The cancer microenvironment plays a pivotal role in oncogenesis, containing a number of regulatory cells that attenuate the anti-neoplastic immune response. While the negative prognostic impact of regulatory T cells (Tregs) in the context of most solid tissue tumors is well established, their role in lymphoid malignancies remains unclear. T cells expressing FOXP3 and Helios were documented in the fine needle aspirates of affected lymph nodes of dogs with spontaneous multicentric B cell lymphoma (BCL), proposed to be a model for human non-Hodgkin lymphoma. Multivariable analysis revealed that the frequency of lymph node FOXP3+ T cells was an independent negative prognostic factor, impacting both progression-free survival (hazard ratio 1.10; p = 0.01) and overall survival (hazard ratio 1.61; p = 0.01) when comparing dogs showing higher than the median FOXP3 expression with those showing the median value of FOXP3 expression or less. Taken together, these data suggest the existence of a population of Tregs operational in canine multicentric BCL that resembles thymic Tregs, which we speculate are co-opted by the tumor from the periphery. We suggest that canine multicentric BCL represents a robust large animal model of human diffuse large BCL, showing clinical, cytological and immunophenotypic similarities with the disease in man, allowing comparative studies of immunoregulatory mechanisms.
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Affiliation(s)
- Dammy Pinheiro
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Yu-Mei Chang
- Research Office, The Royal Veterinary College, London, United Kingdom
| | - Hannah Bryant
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Balazs Szladovits
- Department of Pathology and Pathogen Biology, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Tim Dalessandri
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Lucy J. Davison
- Henry Wellcome Building, Centre for Cellular and Molecular Physiology, University of Oxford, Oxford, United Kingdom
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth Yallop
- Clinical Investigation Centre, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Emily Mills
- Clinical Investigation Centre, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Chiara Leo
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Ana Lara
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Anneliese Stell
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Gerry Polton
- Oncology Service, North Downs Specialist Referrals, Bletchingley, Surrey, United Kingdom
| | - Oliver A. Garden
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
- * E-mail:
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Papakonstantinou S, James O'Brien P. High content imaging for the morphometric diagnosis and immunophenotypic prognosis of canine lymphomas. CYTOMETRY PART B-CLINICAL CYTOMETRY 2014; 86:373-82. [DOI: 10.1002/cyto.b.21170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/22/2014] [Accepted: 02/21/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Stratos Papakonstantinou
- Veterinary Pathobiology Section; School of Veterinary Medicine, University College Dublin; Ireland
| | - Peter James O'Brien
- Veterinary Pathobiology Section; School of Veterinary Medicine, University College Dublin; Ireland
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Abstract
FNA is a simple, safe, and an inexpensive sampling technique that plays an important role in the evaluation of lymphadenopathy. The key to enhancing the accuracy of FNA diagnosis of lymphoma is the multi parameter approach in which the cytomorphologic features are evaluated in correlation with the results of ancillary studies and clinical context. A full understanding of the current lymphoma classification, clinical features associated with each lymphoma subtype and the impact of the diagnosis on patient management is essential in FNA diagnosis of lymphoma. It is also important to recognize the limitations of FNA in the primary diagnosis of some subtypes of lymphoma, and tissue biopsy should be recommended for a definitive diagnosis and subclassification in such cases.
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Affiliation(s)
- Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
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Poggi A, Miniscalco B, Morello E, Comazzi S, Gelain ME, Aresu L, Riondato F. Flow cytometric evaluation of ki67 for the determination of malignancy grade in canine lymphoma. Vet Comp Oncol 2013; 13:475-80. [PMID: 24341365 DOI: 10.1111/vco.12078] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/01/2013] [Accepted: 10/31/2013] [Indexed: 12/26/2022]
Abstract
Ki67 is a nuclear antigen significantly correlated with degree of malignancy in human non-Hodgkin lymphomas. We wanted to assess the ability of flow cytometric evaluation of Ki67 index (Ki67I) in differentiating the grade of malignancy in canine lymphomas. Ki67I was determined on lymph node aspirates of 90 immunophenotyped lymphomas classified according to the updated Kiel classification: 80 high grade (HG, 62 B cell and 18 T cell) and 10 low grade (LG, 3 B cell and 7 T cell) lymphomas. HG lymphomas showed significantly higher Ki67I compared with LG lymphomas (P < 0.0001). A significant difference in HG lymphomas was detected between B- and T-immunophenotypes. Receiver operating characteristic (ROC) curve highlighted a high accuracy of Ki67I in recognizing HG lymphomas [area under the curve (AUC) = 99.4] and a cut-off value of 12.2% was established (sensitivity = 96.3% and specificity = 100%). Thus, we suggest the combination of Ki67I flow cytometric determination and immunophenotype as a reliable tool to classify canine lymphomas.
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Affiliation(s)
- A Poggi
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - B Miniscalco
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - E Morello
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - S Comazzi
- Department of Veterinary Sciences and Public Health, University of Milan, Milan, Italy
| | - M E Gelain
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - L Aresu
- Department of Comparative Biomedicine and Food Science, University of Padua, Padua, Italy
| | - F Riondato
- Department of Veterinary Science, University of Turin, Grugliasco, Italy
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Yarovoy AA, Bulgakova ES, Shatskikh AV, Uzunyan DG, Kleyankina SS, Golubeva OV. CORE needle biopsy of orbital tumors. Graefes Arch Clin Exp Ophthalmol 2013; 251:2057-61. [PMID: 23515750 DOI: 10.1007/s00417-013-2315-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In some orbital mass lesions, histology may be the only way to establish an accurate diagnosis. Core needle biopsy (CNB) is widely performed in oncology, and unlike fine needle aspiration biopsy (FNAB), it can provide sufficient tissue sample for histology and immunohistochemistry. The purpose of this study was to evaluate the usefulness and possible complications of CNB of orbital tumors. METHODS Fifty orbital lesions from 46 patients (age: 2-84 years) were biopsied using 20-gauge and 18-gauge semi-automated needles; 11 procedures were performed under ultrasound guidance. All 50 samples received routine histopathological examination and immunohistochemical analysis. RESULTS Specimens diagnostically sufficient for histological analysis were obtained in all biopsies. The histopathological diagnosis was established in 94% of specimens: 30 tumors were malignant: lymphoma (20); rhabdomyosarcoma (six); lacrimal gland carcinoma (one); breast carcinoma metastasis (two); melanoma (one); three were benign; ten inflammatory; and four were orbital fibrosis. Three biopsies were nondiagnostic: two (lymphoma, angiofibroma) showed undetermined identification and one was a false-negative (lacrimal gland adenocarcinoma was misdiagnosed as fibrous tissue). The diagnoses were confirmed by excisional or incisional biopsy in 26 patients. The concordance rate in patients with a surgically confirmed diagnosis was 88%. The sensitivity, specificity and accuracy for differentiating malignant from benign lesions were 94%, 100%, and 96%, respectively. Two patients suffered complications: mild retrobulbar hematoma with no decreased visual acuity. There was no damage to the globe or optic nerve, motility disorder, or infection. CONCLUSIONS CNB of orbital mass lesions is a safe procedure that provides a sufficient amount of tissue for histology and immunohistochemistry, and may be useful for improving the quality of the pathological diagnosis of orbital tumors.
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Affiliation(s)
- Andrey A Yarovoy
- Ocular Oncology Department, The S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky blvd., 59A, 127486 Moscow, Russia.
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Pedersen OM, Aarstad HJ, Løkeland T, Bostad L. Diagnostic yield of biopsies of cervical lymph nodes using a large (14-gauge) core biopsy needle. APMIS 2013; 121:1119-30. [DOI: 10.1111/apm.12058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 01/22/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Ole M. Pedersen
- Department of Heart Disease; Institute of Medicine; Haukeland University Hospital; Bergen Norway
| | - Hans J. Aarstad
- Department of Otolaryngology and Head and Neck Surgery; Haukeland University Hospital; Bergen Norway
| | - Turid Løkeland
- Department of Oncology and Medical Physics; Haukeland University Hospital; Bergen Norway
| | - Leif Bostad
- Department of Pathology; Haukeland University Hospital; Bergen Norway
- The Gade Institute Section for Pathology; Haukeland University Hospital; Bergen Norway
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Diagnosis of B-cell non-hodgkin lymphomas with small-/intermediate-sized cells in cytopathology. PATHOLOGY RESEARCH INTERNATIONAL 2012; 2012:164934. [PMID: 22693682 PMCID: PMC3368210 DOI: 10.1155/2012/164934] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 03/15/2012] [Indexed: 11/17/2022]
Abstract
Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls.
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Zeppa P, Sosa Fernandez LV, Cozzolino I, Ronga V, Genesio R, Salatiello M, Picardi M, Malapelle U, Troncone G, Vigliar E. Immunoglobulin heavy-chain fluorescence in situ hybridization-chromogenic in situ hybridization DNA probe split signal in the clonality assessment of lymphoproliferative processes on cytological samples. Cancer Cytopathol 2012; 120:390-400. [PMID: 22517675 DOI: 10.1002/cncy.21203] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/27/2012] [Accepted: 03/22/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The human immunoglobulin heavy-chain (IGH) locus at chromosome 14q32 is frequently involved in different translocations of non-Hodgkin lymphoma (NHL), and the detection of any breakage involving the IGH locus should identify a B-cell NHL. The split-signal IGH fluorescence in situ hybridization-chromogenic in situ hybridization (FISH-CISH) DNA probe is a mixture of 2 fluorochrome-labeled DNAs: a green one that binds the telomeric segment and a red one that binds the centromeric segment, both on the IGH breakpoint. In the current study, the authors tested the capability of the IGH FISH-CISH DNA probe to detect IGH translocations and diagnose B-cell lymphoproliferative processes on cytological samples. METHODS Fifty cytological specimens from cases of lymphoproliferative processes were tested using the split-signal IGH FISH-CISH DNA probe and the results were compared with light-chain assessment by flow cytometry (FC), IGH status was tested by polymerase chain reaction (PCR), and clinicohistological data. RESULTS The signal score produced comparable results on FISH and CISH analysis and detected 29 positive, 15 negative, and 6 inadequate cases; there were 29 true-positive cases (66%), 9 true-negative cases (20%), 6 false-negative cases (14%), and no false-positive cases (0%). Comparing the sensitivity of the IGH FISH-CISH DNA split probe with FC and PCR, the highest sensitivity was obtained by FC, followed by FISH-CISH and PCR. CONCLUSIONS The split-signal IGH FISH-CISH DNA probe is effective in detecting any translocation involving the IGH locus. This probe can be used on different samples from different B-cell lymphoproliferative processes, although it is not useful for classifying specific entities. Cancer (Cancer Cytopathol) 2012;. © 2012 American Cancer Society.
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Affiliation(s)
- Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
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de Kerviler E, Benet C, Brière J, de Bazelaire C. Image-guided needle biopsy for diagnosis and molecular biology in lymphomas. Best Pract Res Clin Haematol 2012; 25:29-39. [DOI: 10.1016/j.beha.2012.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Said Raddaoui EM, Sayage-Rabie L, Beissner RS. Fine needle aspiration cytology in the evaluation of lymphoid lesions: a retrospective study of the utility of flow cytometry in conjunction with morphology. Ann Saudi Med 2012; 32:137-42. [PMID: 22366826 PMCID: PMC6086635 DOI: 10.5144/0256-4947.2012.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Fine needle aspiration (FNA) cytology, in conjunction with flow cytometry, is now widely used as a reliable and accurate method for the assessment of various lymphoid lesions, especially for lesions situated in odd locations where obtaining biopsy and monitoring for recurrence in previously diagnosed cases of lymphoma are difficult. The objective of this study was to determine the utility of FNA and immunophenotyping in the assessment of lymphoid lesions, and to find whether flow cytometry is more useful in the evaluation and subclassification of the small cell morphology group of lymphomas than in the large cell morphology group of lymphomas. DESIGN AND SETTING Retrospective analysis of patients diagnosed with lymphoma over at a 5-year period. PATIENTS AND METHODS All 175 FNA cases were followed carefully either clinically or histologically for at least 5 years. We compared the utility of flow cytometry in the diagnosis of small cell morphology lymphomas to large cell morphology lymphomas. RESULTS Flow cytometry was performed on 72 of 175 (41%) of FNA specimens clinically suspicious of lymphoma. The excisional follow-up biopsy was obtained in 78 of 175 (44.5%) cases. Based on cytomorphologic evaluation, 82 cases (47%) were considered negative, 34 cases (19%) were considered atypical, 32 cases (18%) were positive for NHL-small cell morphology, 21 cases (12%) were positive for non-Hodgkin lymphoma (NHL)-large cell morphology, 3 cases (2%) were positive for NHL, and 3 cases (2%) were nondiagnostic. Immunophenotyping utilizing flow cytometry was the diagnostic parameter in 28 of 32 cases (88%) of the NHL-small cell morphology group and in 11 of 24 cases (46%) of the NHL-large cell morphology/Hodgkin lymphoma group. CONCLUSIONS Immunophenotyping by flow cytometry is more essential for the accurate evaluation and classification of small cell morphology than large cell morphology lymphoid lesions in FNA cytology.
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Affiliation(s)
- Emad M Said Raddaoui
- Department of Pathology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Diagnostic value of fine-needle aspiration in head and neck lymphoma: a cross-sectional study. Indian J Otolaryngol Head Neck Surg 2012; 66:277-80. [PMID: 24533398 DOI: 10.1007/s12070-012-0484-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022] Open
Abstract
The objective of this paper was that fine-needle aspiration (FNA) has become a well-liked modality in the diagnosis, staging, and follow-up of head and neck masses. Limited studies exist regarding the value of FNA in the diagnosis of head and neck masses. We aimed to evaluate the diagnostic value of head and neck lymphomas. This cross-sectional study method was performed in Imam Hospital and Cancer Institute affiliated to Tehran University of Medical Sciences. In a 5 years period between January 2006 and June 2010, we enrolled all patients with cervical mass (es) who had undergone FNA as the primary diagnostic modality and then underwent biopsy (excisional or open). Results of FNA were compared with histopathological study as a gold standard method. Finally, 47 patients were recruited. It was found that FNA had a sensitivity of 88% (CI 95% = 79-97), a specificity of 81.2% (CI 95% = 70-92), a positive predictive value of 84.6% (CI 95% = 75-95), a negative predictive value of 85.7% (CI 95% = 77-95) and an accuracy of 85.1% (CI 95% = 75-95) in the diagnosis of head and neck lymphoma. We conclude that FNA has a considerable value in differentiation of head and neck lymphoma from non-lymphoma etiologies and is recommended as a screening test for the diagnosis of head and neck lymphoma.
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Hafez NH, Tahoun NS. Reliability of fine needle aspiration cytology (FNAC) as a diagnostic tool in cases of cervical lymphadenopathy. J Egypt Natl Canc Inst 2011; 23:105-14. [PMID: 22776815 DOI: 10.1016/j.jnci.2011.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this work is to evaluate the reliability and diagnostic accuracy of fine needle aspiration cytology (FNAC) of cervical lymph nodes with an emphasis on discordant cases between the cytology and the histopathology. PATIENTS AND METHODS This retrospective study was conducted on 157 selected patients with cervical lymphadenopathy that had undergone FNAC. Cervical nodal enlargement was the first clinical manifestation of the patients in all cases. Hypocelluar slides were excluded from the current study. The cytopathological diagnoses were compared with the histopathological results of the same excised nodes. For all discordant cases, special attention was focused on the cytomorphological features. Diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and discordance rate were calculated. RESULTS The cytological diagnoses were found to be benign in 48 cases (30.6%) and malignant in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2% (129/157), while the overall discordance rate was 17.8% (28/157). The diagnostic accuracy of reactive lymphoid hyperplasia, chronic necrotizing lymphadenitis, chronic granulomatous lymphadenitis, metastatic carcinoma, Hodgkin lymphoma, and Non Hodgkin lymphoma was 85%, 83.3%, 70%, 100%, 77.8%, and 75%, respectively. CONCLUSION The overall diagnostic accuracy of FNAC of cervical lymph nodes was 82.2% while the overall discordance rate was 17.8%. The evaluation of FNA in patients with no previously diagnosed malignancy should be interpreted by an experienced cytopathologist in the context of clinical, radiological, and laboratory finding and if any of these findings is suspicious, further investigation is justified to overcome the limitations and pitfalls of the cytomorphological features when applied alone.
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Affiliation(s)
- Nesreen H Hafez
- Department of Pathology, Cytopathology Unit, National Cancer Institute (NCI), Cairo University, Egypt.
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Ko HM, da Cunha Santos G, Darling G, Pierre A, Yasufuku K, Boerner SL, Geddie WR. Diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration. Diagn Cytopathol 2011; 41:1023-30. [PMID: 21630485 DOI: 10.1002/dc.21741] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/16/2011] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been established for staging mediastinal lymph nodes in lung carcinoma patients with radiologically enlarged lymph nodes, but its utility for evaluation of primary lymph node disorders is not well defined. The objective of this study was to evaluate the usefulness of EBUS-TBNA with on-site assessment and triage of sample for multiple ancillary techniques, for the diagnosis and subclassification of lymphomas and non-neoplastic lesions involving mediastinal lymph nodes. METHODS One hundred and twenty consecutive patients who underwent EBUS-TBNA between January 2008 and August 2009 were reviewed. The final cytological diagnosis was based on air-dried Romanowsky and alcohol-fixed Papanicolaou stained direct smears, immunohistochemistry, immunophenotyping, and fluorescence in situ hybridization (FISH). RESULTS A total of 38 cases were included in this study consisting of eight reactive lymphoid hyperplasia, 20 granulomatous lymphadenitis (17 non-necrotizing and 3 necrotizing granulomatous inflammations), 3 Hodgkin lymphomas and 7 non-Hodgkin lymphomas (1 small lymphocytic lymphoma (SLL), 1 SLL with scattered Reed-Sternberg cells, 1 marginal zone lymphoma, and 4 large B cell lymphomas). Cultures performed in 13 cases were negative for AFB and fungi. Immunophenotyping and immunohistochemistry for MIB1 in six cases, and FISH in five cases provided necessary information for subclassification. CONCLUSIONS EBUS-TBNA is a minimally invasive procedure which provides sufficient sample for definitive primary diagnosis and classification of malignant lymphoma and granulomatous inflammation in patients with mediastinal lymphadenopathy. Rapid on-site specimen assessment is invaluable for appropriate assignment of sample to ancillary studies.
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Affiliation(s)
- Hyang Mi Ko
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
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Marconato L. The staging and treatment of multicentric high-grade lymphoma in dogs: a review of recent developments and future prospects. Vet J 2011; 188:34-8. [PMID: 20627636 DOI: 10.1016/j.tvjl.2010.04.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 04/22/2010] [Accepted: 04/24/2010] [Indexed: 11/18/2022]
Abstract
In recent years, considerable progress has been made in understanding the biology of canine lymphoma with resultant enhanced classification schemes and the possibility of individualised, tailored therapies. However, although complete remission may be achieved using multi-agent chemotherapy, the mortality rate from this neoplasm remains high. This review focuses on the staging of high-grade multicentric lymphoma in the dog, on conventional and novel treatment strategies (including chemotherapy, bone marrow transplantation, radiation therapy and molecular-targeted agents), and on the management of relapsed or refractory cases.
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Affiliation(s)
- Laura Marconato
- Animal Oncology and Imaging Center, 6331 Hünenberg, Switzerland.
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Das DK, Pathan SK, Mothaffer FJ, John B, Mallik MK, Sheikh ZA, Haji BE, Amir T, Francis IM. T-cell-rich B-cell lymphoma (TCRBCL): Limitations in fine-needle aspiration cytodiagnosis. Diagn Cytopathol 2011; 40:956-63. [DOI: 10.1002/dc.21683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 02/05/2011] [Indexed: 11/10/2022]
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40
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Barrena S, Almeida J, Del Carmen García-Macias M, López A, Rasillo A, Sayagués JM, Rivas RA, Gutiérrez ML, Ciudad J, Flores T, Balanzategui A, Caballero MD, Orfao A. Flow cytometry immunophenotyping of fine-needle aspiration specimens: utility in the diagnosis and classification of non-Hodgkin lymphomas. Histopathology 2011; 58:906-18. [DOI: 10.1111/j.1365-2559.2011.03804.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Savage EC, Vanderheyden AD, Bell AM, Syrbu SI, Jensen CS. Independent diagnostic accuracy of flow cytometry obtained from fine-needle aspirates: a 10-year experience with 451 cases. Am J Clin Pathol 2011; 135:304-9. [PMID: 21228371 DOI: 10.1309/ajcphy69xvjgulko] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Although the topic is somewhat contentious, fine-needle aspiration (FNA) is frequently used in conjunction with flow cytometry (FC) to evaluate lymphoid proliferations. Despite the fact that the FNA and FC are often analyzed independently, no previous large-scale study has independently analyzed FC of FNA specimens. FC reports of 511 FNAs were retrospectively reviewed and FC diagnoses categorized as monoclonal, atypical, normal/reactive, or insufficient cellularity (3.9%). Abnormal immunophenotype was considered a positive test result. "Gold standard" diagnoses were established by histologic examination, treatment based on FNA, or clinical features. In 92.2% (451/489), there was adequate follow-up. The diagnostic accuracy of FC was 88.4%, sensitivity was 85.8%, and specificity was 92.9%. In addition, FC accuracy for classes of non-Hodgkin lymphoma was assessed. We conclude that FC is an independently accurate ancillary test in the evaluation of FNA. However, the presence of false-negative and false-positive cases supports the common practice of correlating FC with cytomorphologic findings even if performed independently.
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Affiliation(s)
- Erica C. Savage
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
| | | | - Adam M. Bell
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
| | - Sergei I. Syrbu
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
| | - Chris S. Jensen
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City
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Alam K, Jain A, Maheshwari V, Siddiqui FA, Haider N, Khan AH. Fine-needle aspiration cytology diagnosis of non-Hodgkins lymphoma in a resource-challenged environment. Diagn Cytopathol 2010; 39:461-7. [DOI: 10.1002/dc.21447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 04/17/2010] [Indexed: 11/11/2022]
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Utility of Flow Cytometry Immunophenotyping in Fine-needle Aspirate Cytologic Diagnosis of Non-Hodgkin Lymphoma. Appl Immunohistochem Mol Morphol 2010; 18:311-22. [DOI: 10.1097/pai.0b013e3181827da8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lymph nodes. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Janikova A, Mayer J, Kren L, Smardova J, Dvorakova D, Neubauer J, Vasova I. The persistence of t(14;18)-bearing cells in lymph nodes of patients with follicular lymphoma in complete remission: the evidence for 'a lymphoma stem cell'. Leuk Lymphoma 2009; 50:1102-9. [PMID: 19557630 DOI: 10.1080/10428190902927005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Monitoring of t(14;18) in blood or bone marrow in follicular lymphoma (FL) remains controversial. We attempted to monitor t(14;18) in lymph nodes by ultrasound-guided fine needle aspirations (UG-FNA). First, we confirmed t(14;18) in 27/31 UG-FNAs of lymph nodes with fluorescent in situ hybridisation (FISH) and/or polymerase chain reaction (PCR) in patients with advanced disease. In complete (CR) and molecular remission, there were repeated 18 UG-FNAs in 17 patients. Five of 18 UG-FNA were technically unsuccessful and 6/18 samples contained fibrosis. Despite that, these patients had a better prognosis. In 7/7 aspirations in six patients, t(14;18) was detected. Three patients are still in CR, even one of them remains in long lasting remission despite two consecutive evidences of t(14;18) in UG-FNA. Another three of these patients relapsed a few months after UG-FNA. This study is proof of the principle of the detection of residual t(14;18) bearing cells in previously involved lymph nodes despite patients being in remission.
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Affiliation(s)
- Andrea Janikova
- Department of Internal Medicine, Hemato-Oncology, University Hospital Brno, Czech Republic.
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Das DK, Francis IM, Sharma PN, Sathar SA, John B, George SS, Mallik MK, Sheikh ZA, Haji BE, Pathan SK, Madda JP, Mirza K, Ahmed MS, Junaid TA. Hodgkin's lymphoma: Diagnostic difficulties in fine-needle aspiration cytology. Diagn Cytopathol 2009; 37:564-73. [DOI: 10.1002/dc.21064] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pfeiffer J, Kayser G, Ridder GJ. Sonography-assisted cutting needle biopsy in the head and neck for the diagnosis of lymphoma: Can it replace lymph node extirpation? Laryngoscope 2009; 119:689-95. [DOI: 10.1002/lary.20110] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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48
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Diagnostic effectiveness of sonography-assisted cutting needle biopsy in uncommon cervicofacial lesions. ACTA ACUST UNITED AC 2009; 107:173-9. [DOI: 10.1016/j.tripleo.2008.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 06/06/2008] [Accepted: 06/25/2008] [Indexed: 11/24/2022]
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Swart GJ, Wright C, Brundyn K, Mansvelt E, Plessis MD, Oever DT, Jacobs P. Fine needle aspiration biopsy and flow cytometry in the diagnosis of lymphoma. Transfus Apher Sci 2007; 37:71-9. [DOI: 10.1016/j.transci.2007.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 10/22/2022]
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de Larrinoa AF, del Cura J, Zabala R, Fuertes E, Bilbao F, Lopez JI. Value of ultrasound-guided core biopsy in the diagnosis of malignant lymphoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:295-301. [PMID: 17486566 DOI: 10.1002/jcu.20383] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Ultrasound-guided core needle biopsy for the diagnosis and management of malignant lymphomas is controversial and has not been accepted as an alternative to surgical biopsy. We investigate the clinical usefulness of this procedure in a large series of patients. METHODS Over a 5-year period (2000-2004), ultrasound-guided core needle biopsies were performed in 102 malignant lymphomas. Five diagnostic categories were considered: large B-cell lymphomas (LBCL), small B-cell lymphomas (SBCL), Hodgkin's disease (HD), T cell lymphomas, and miscellaneous. Surgical excisional biopsy of the node was performed in 47 cases (46.1%) for diagnostic confirmation. RESULTS The overall diagnostic accuracy of ultrasound-guided core needle biopsy was 88.2% (90/102). SBCL (39), LBCL (36), HD (15), T cell lymphomas (5), and miscellaneous (7) [including T cell-rich B cell (2), natural killer cell (1), Burkitt's lymphoma (1), and non-Hodgkin's lymphoma of the B cell type, NOS (3)] were correctly diagnosed. Three HDs, 1 natural killer cell lymphoma, 1 follicular lymphoma, and 1 LBCL were not correctly diagnosed. The core needle biopsy did not yield tumor tissue in 6 cases. CONCLUSIONS Ultrasound-guided core needle biopsy is effective in the diagnosis of malignant lymphomas and can be used as the first diagnostic approach in selected clinical situations.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy/methods
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/pathology
- Female
- Hodgkin Disease/diagnosis
- Humans
- Killer Cells, Natural/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Lymph Nodes/pathology
- Lymphoma/diagnosis
- Lymphoma/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, Follicular/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, T-Cell/diagnosis
- Male
- Middle Aged
- Prospective Studies
- Ultrasonography, Interventional
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