Immunophenotyping of non-Hodgkin’s lymphoma by flowcytometry on fine needle aspiration
Keywords:Flowcytometry, Non-Hodgkin’s lymphoma, Fine needle aspiration cytology, Reactive hyperplasia
Background: Lymphoma represents one of the major health problems all over the world. Flow cytometry (FCM) can be used on fine-needle aspiration cytology (FNAC) from lymph node as an ancillary technique. Aim of the study was to assess the utility of flowcytometry (FCM) in diagnosis and differentiation of reactive hyperplasia and non-Hodgkin’s lymphoma (NHL) on FNAC.
Methods: The study was carried out on 50 cases, 25 each of reactive hyperplasia and suspicious or confirmed NHL on FNAC. FCI was performed with a complete panel of antibodies on FACS Canto II FCM.
Results: All 25 cases of reactive hyperplasia on FNAC were polyclonal on FCM. FCM could be performed in 22 cases (88%) out of 25 suspicious NHL and in three cases the material was inadequate on aspirate. Out of 22 cases of NHL on FNAC 17 cases (77.30%) were diagnosed as B-NHL on FCM. Light chain restriction was demonstrated in 15/17 cases. With the help of FCI, 6 cases were diagnosed as small cell lymphocytic lymphoma, one case as mantle cell lymphoma, one case as follicular lymphoma, and 9 cases as B-NHL-NOS. Histopathology diagnosis was available in nine cases and were in concordance to FCM. Sensitivity of combined FNAC and FCM in sub-classification was 77.30% (17/22). Four cases showed discordance between FNAC and FCM.
Conclusion: We concluded that FCM enhances the diagnostic ability of FNAC, playing a crucial role in a rapid and accurate differential diagnosis between reactive hyperplasia, B-NHL and T-NHL.
El-Sayed AM, El-Borai MH, Bahnassy AA, El-Gerzawi S. Flow cytometric immunophenotyping (FCI) of lymphoma: correlation with histopathology and immunohistochemistry. Diagn Pathol. 2008;3:43.
Orell SR, Sterer GF, Whitaker D. Fine needle aspiration cytology, 4th edition. Churchill Livingston. 2005;1(8):83-124.
Bakke AC. The Principles of Flow Cytometry. Lab Med. 2001;4(32):207-11.
Kaleem Z, White G, Vollmer RT. Critical analysis and diagnostic usefulness of limited immunophenotyping of B-cell non-Hodgkin lymphomas and flow cytometry. Am J Clin Pathol. 2001;115:136-42.
Jeffers MD, Milton J, Herriot R, McKean M. Fine needle aspiration cytology in investigation on non-Hodgkin’s lymphoma. J Clin Pathol. 1998;51:189-96.
Saboorian MH, Ashfaq R. The use of fine needle aspiration biopsy in the evaluation of lymphadenopathy. Semin Diagn Pathol. 2001;18:110-23.
Nicol TL, Silberman M, Rosenthal DL, Borowitz MJ. The accuracy of combined cytopathologic and flow cytometric analysis of fine-needle aspirates of lymph nodes. Am J Clin Pathol. 2000;114:18-28.
Meda BA, Buss DH, Woodruff RD. Diagnosis and subclassification of primary and recurrent lymphoma. The usefulness and limitations of combined fine-needle aspiration cytomorphology and flow cytometry. Am J Clin Pathol. 2000;113:688-99.
Dong HY, Harris NL, Preffer FI, Pitman MB. Fine-needle aspiration biopsy in the diagnosis and classification of primary and recurrent lymphoma: a retrospective analysis of the utility of cytomorphology and flow cytometry. Mod Pathol. 2001;14:472-81.
Leong ASY, Stevens M. Fine-needle aspiration biopsy for the diagnosis of lymphoma: a perspective. Diagn Cytopathol .1996;15:352-7.
Dey P, Amir T, Al Jassar A, Al Shemmari S, Jogai S, Bhat MG, et al. Combined applications of fine needle aspiration cytology and flow cytometric immunphenotyping for diagnosis and classification of non-Hodgkin’s lymphoma. Cyto J. 2006;3:24.
Barroca H, Marques C, Candeias J. Fine needle aspiration cytology diagnosis, flow cytometry immunophenotyping and histology in clinically suspected lymphoproliferative disorder. Acta Cytol. 2008;52:124-32.
Zeppa P, Marino G, Troncone G, Fulciniti F, De Renzo. Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin’s lymphoma: a critical review of 307 cases with technical suggestions. Cancer. 2004;102(1):55-65.
Zeppa P, Vigliar E, Cozzolino I, TronconeG, Picardi M, De Renzo A, et al. Fine needle aspiration cytology and flow cytometry immunophenotyping of non-Hodgkin’s lymphoma: can we do better? Cytopathology. 2010;21(5):300-10.
Siebert JD, Weeks LM, List LW, Kugler JW, Knost JA, Fishkin PA et al. Utility of flow cytometry immunophenotyping for the diagnosis and classification of lymphoma in community hospital clinical needle aspiration/biopsies. Arch Pathol Lab Med. 2000;124:1792-9.
Mourad WA, Tulbah A, Shoukri MM, Al Dayel F, Akhtar M, Ali MA, et al. Primary diagnosis and REAL/WHO classification of non-Hodgkin’s lymphoma by fine-needle aspiration: cytomorphologic and immunophenotypic approach. Diagn Cytopathol. 2003;28(4):191-5.
Mayall F, Dray M, Stanley D, Harrison B, Allen R. Immunoflow cytometry and cell block immunohistochemistry in the FNA diagnosis of lymphoma: a review of 73 consecutive cases. J Clin Pathol. 2000;53(6):451-7.