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14.00–15.00 Tuesday 16 September 2003 9 A comprehensive cellular pathology approach to lymphoma diagnosis: a 3‐year audit
Author(s) -
Nawabuddin Aisha,
Wilson Philip O. G.
Publication year - 2003
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1046/j.1365-2303.14.s1.1_14.x
Subject(s) - medicine , lymphoma , biopsy , fine needle aspiration , cytology , pathology , radiology , audit , management , economics
We promote FNA as the first line investigation for lymphadenopathy. Patients subjected to FNA have direct smears and needle rinses routinely prepared for morphological interpretation and, if appropriate, immunosuspension (using immunoflourescence and FACS), immunostaining, microbiology investigations, and PCR. Patients with a cytological diagnosis of lymphoma are then subjected to surgical biopsy if clinically appropriate. We are aware that in many haemato‐oncology services, especially those where the pathologist has only limited experience of cytology, FNA is regarded as either inferior to histology, or of no use, in identifying and classifying lymphomas. In this audit we address this misconception. All cases coded by SNOMED as lymphoma at St George's between January 2000 and December 2002 were retrieved and their diagnostic pathway was reviewed. We identified those cases that had preceding FNA from those that did not, and we determined which samples had which ancillary tests. Our audit shows that:• FNA is highly sensitive for B‐cell lymphoma, which is increased by immunosuspension studies to 100%. • FNA has a lower sensitivity for T‐cell lymphoma, which is slightly increased by immunosuspension studies to 73%. • FNA has a lower sensitivity for Hodgkin lymphoma of 73%, which is not increased by immunosuspension studies. • We do not use PCR enough for statistically significant data on its utility. • Core biopsy provides no information than cannot be obtained by FNA.We conclude that:• FNA is an appropriate means of identifying and classifying lymphoma. • The utility of FNA is greatly enhanced by ancillary tests, especially immunosuspension studies. • Core biopsy is no better than FNA for diagnosing and classifying lymphoma. • Excision biopsy is still important in the comprehensive documentation of lymphoma. • Excision biopsy is an essential second line investigation in cases where the lymphadenopathy persists or progresses regardless of the FNA findings.