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Volaric AK, Lin O, Zadeh SL, Gupta S, Reed DR, Fitzpatrick MJ, Ly A, Hasserjian RP, Balassanian R, Frank AK, Long S, Ruiz-Cordero R, Wang L, Wen KW, Xie Y, Mou E, Falchi L, Cook S, Menke JR, Natkunam Y, Gratzinger D. Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma: A Multi-Institutional Collaborative Study. Am J Surg Pathol 2023; 47:212-217. [PMID: 36537240 PMCID: PMC10464531 DOI: 10.1097/pas.0000000000001985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Small-volume biopsies (SVBs) including fine-needle aspiration (FNA), cell block, and needle core biopsies (NCB) are increasingly utilized to diagnose and guide the clinical management of lymphoma. We established a multi-institutional interdisciplinary collaboration of cytopathologists, hematopathologists, and oncologists focused on the role of SVB in the management of patients with follicular lymphoma (FL). To assess the performance characteristics of SVB in this setting, we evaluated all consecutive SVBs performed for clinical indications of initial diagnosis, recurrence, or transformation of FL over a 5-year period and focused on the 182 that had at least one subsequent biopsy within 3 months as part of the same clinical work-up. The most common outcome of a subsequent biopsy as part of the same clinical work-up was a more specific diagnosis usually assigning the pathologic grade (111/182, 61%), followed by a complete agreement with the SVB (24/182, 13%), and change from nondiagnostic on initial biopsy to diagnostic on subsequent biopsy (21/182, 12%). A minority resulted in a diagnostic change from benign to lymphoma (17/182, 9%), a change in FL grade (5/182, 3%), or change in the lymphoma diagnostic category (4/182, 2%). There were no cases where an initial diagnosis of lymphoma was overturned. The distribution of discrepancies was similar across initial SVB types (FNA, FNA + cell block, NCB with or without FNA). Tissue limitations were noted in a minority of cases (53/182, 29%) and were enriched among initially nondiagnostic biopsies (16/21, 76%). Flow cytometry immunophenotyping was performed in the majority of cases both at the first and last biopsy (147/182, 81%). SVB can be a powerful method to detect FL in various clinical indications, with discrepant cases mostly resulting from a refinement in the initial diagnosis.
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Affiliation(s)
- Ashley K. Volaric
- Department of Pathology, Stanford University, Stanford, CA
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sara L. Zadeh
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Srishti Gupta
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Daniel R. Reed
- Section on Hematology/Oncology, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | - Ronald Balassanian
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Annabel K. Frank
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA
| | - Steven Long
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Roberto Ruiz-Cordero
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Linlin Wang
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Kwun Wah Wen
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Yi Xie
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa Health Care, Iowa City, IA
| | - Lorenzo Falchi
- Department of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen Cook
- Department of Pathology, Veteran Affairs Medical Center, San Francisco, CA
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Ali AE, Morgen EK, Geddie WR, Boerner SL, Massey C, Bailey DJ, da Cunha Santos G. Classifying B-cell non-Hodgkin lymphoma by using MIB-1 proliferative index in fine-needle aspirates. Cancer Cytopathol 2010; 118:166-72. [PMID: 20544708 DOI: 10.1002/cncy.20075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND MIB-1 proliferation index (PI) has proven helpful for diagnosis and prognosis in non-Hodgkin lymphomas (NHLs). However, validated cutoff values for use in fine-needle aspiration (FNA) samples are not available. We investigated MIB-1 immunocytochemistry as an ancillary technique for stratifying NHL and attempted to establish PI cutpoints in cytologic samples. METHODS B-cell NHL FNA cases with available cytospins (CS) MIB-1 immunocytochemistry results were included. Demographic, molecular, immunophenotyping and MIB-1 PI data were collected from cytologic reports. Cases were subtyped according to the current World Health Organization classification and separated into indolent, aggressive, and highly aggressive groups. Statistical analysis was performed with pairwise Wilcoxon rank sum test and linear discriminant analysis to suggest appropriate PI cutpoints. RESULTS Ninety-one NHL cases were subdivided in 56 (61.5%) indolent, 30 (33%) aggressive, and 5 (5.5%) highly aggressive lymphomas. The 3 groups had significantly different MIB-1 PIs from each other. Cutpoints were established for separating indolent (<38%), aggressive (> or =38% to < or =80.1%) and highly aggressive (>80.1%). The groups were adequately predicted in 76 cases (83.5%) using the cutpoints and 15 cases showed discrepant PIs. CONCLUSIONS MIB-1 immunohistochemistry on CS can help to stratify B-cell NHL and showed a significant increase in PI with tumor aggressiveness. Six misclassified cases had PIs close to the cutpoints. Discrepant MIB-1 PIs were related to dilution of positive cells by non-neoplastic lymphocytes and to the overlapping continuum of features between diffuse large B-cell lymphoma and Burkitt lymphoma. Validation of our approach in an unrelated, prospective dataset is required.
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Affiliation(s)
- Abdullah E Ali
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
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Abstract
Fine-needle aspiration biopsy (FNA) is a useful tool for evaluating and staging follicular lymphoma (FL) without subjecting patients to multiple excisional biopsies. The relative lack of architecture in FNA is a limitation in grading FL. Recognizing the various cellular components in aspirates of FL, correlating with flow cytometry, using other ancillary tests, and preparing cell blocks can help overcome difficulties in the grading process. Understanding the clinical relevance of distinguishing the various grades of FL is important in determining whether an aspiration biopsy is adequate or whether additional sampling by surgical biopsy is indicated.
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Affiliation(s)
- Nancy A Young
- Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
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