Skip to main content
SpringerLink
Log in

Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

The clarification of enlarged lymph nodes is a common issue in clinical routine. By now, open surgery with complete lymph node extirpation, followed by histopathology, is considered as standard. We investigated the value of fine needle aspiration (FNA) and core needle biopsy (CNB) when supporting the conventional morphology by immunotyping. In total, 101 lymph nodes (reactive, n = 19; lymphoma, n = 46; metastatic, n = 36) were examined. CNB specimens were sufficient for unequivocal diagnosis by histopathology in 95 %. The FNA cytology allowed a correct diagnosis in 49 %. When supported by immunocytology, the success rate improved to 72 %. By accepting “suspicious of” as correct diagnosis, the ratio increased to 91 %. Additional use of flow cytometry in 46 samples minimized the “suspicious of” diagnoses and increased the proportion of unequivocal diagnoses in FNA specimens to 87 %. Flow cytometry allowed a correct subtyping in 20 of 21 B cell lymphoma but recognised only one of five Hodgkin lymphoma. All eight reactive samples were correctly diagnosed by flow cytometry. In summary, CNB allows a reliable clarification of an unclear lymphadenopathy. FNA is a powerful first diagnostic approach, especially if cytology is supported by immunocytology. The most substantial contribution of flow cytometry in FNA is the discrimination between reactive lymphadenopathy and B cell lymphoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brahimi M, Arabi A, Soltan BE, Osmani S, Benradouane H, Bey M, Yafour N, Benzineb B, Attaf F, Seddiki I, Rahal S, Bekadja MA (2011) How we assess adequacy of fine-needle aspiration materials intended for flow cytometric analysis. Hematol Oncol Stem Cell Ther 4:37–40

    PubMed  CAS  Google Scholar 

  2. Cardillo MR (1989) Fine-needle aspiration cytology of superficial lymph nodes. Diagn Cytopathol 5:166–173

    Article  PubMed  CAS  Google Scholar 

  3. Cartagena N Jr, Katz RL, Hirsch-Ginsberg C, Childs CC, Ordonez NG, Cabanillas F (1992) Efficacy of diagnosis of malignant lymphoma by combining fine-needle aspiration cytomorphology with immunocytochemistry and in selected cases, Southern blotting of aspirated cells: a tissue-controlled study of 86 patients. Diagn Cytopathol 8:456–464

    Article  PubMed  Google Scholar 

  4. Das DK (1999) Value and limitations of fine-needle aspiration cytology in diagnosis and classification of lymphomas: a review. Diagn Cytopathol 21:240–249

    Article  PubMed  CAS  Google Scholar 

  5. Dey P, Amir T, Al JA, Al SS, Jogai S, Bhat MG, Al QA, Al SZ (2006) Combined applications of fine needle aspiration cytology and flow cytometric immunophenotyping for diagnosis and classification of non Hodgkin lymphoma. Cytojournal 3:24

    Article  PubMed  Google Scholar 

  6. Gong JZ, Snyder MJ, Lagoo AS, Vollmer RT, Dash RR, Madden JF, Buckley PJ, Jones CK (2004) Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma. Diagn Cytopathol 31:23–30

    Article  PubMed  Google Scholar 

  7. Laane E, Tani E, Bjorklund E, Elmberger G, Everaus H, Skoog L, Porwit-MacDonald A (2005) Flow cytometric immunophenotyping including Bcl-2 detection on fine needle aspirates in the diagnosis of reactive lymphadenopathy and non-Hodgkin's lymphoma. Cytometry B Clin Cytom 64:34–42

    PubMed  Google Scholar 

  8. Nicol TL, Silberman M, Rosenthal DL, Borowitz MJ (2000) The efficacy of combined cytopathologic and flow cytometric analysis of fine-needle aspirates of lymph nodes. Am J Clin Pathol 114:18–28

    Article  PubMed  CAS  Google Scholar 

  9. Qizilbash AH, Elavathil LJ, Chen V, Young JE, Archibald SD (1985) Aspiration biopsy cytology of lymph nodes in malignant lymphoma. Diagn Cytopathol 1:18–22

    Article  PubMed  CAS  Google Scholar 

  10. Schafernak KT, Kluskens LF, Ariga R, Reddy VB, Gattuso P (2003) Fine-needle aspiration of superficial and deeply seated lymph nodes on patients with and without a history of malignancy: review of 439 cases. Diagn Cytopathol 29:315–319

    Article  PubMed  Google Scholar 

  11. Wakely PE Jr (1998) Fine needle aspiration cytopathology of malignant lymphoma. Clin Lab Med 18:541–543

    PubMed  Google Scholar 

  12. Wakely PE Jr (2010) The diagnosis of non-Hodgkin lymphoma using fine-needle aspiration cytopathology: a work in progress. Cancer Cytopathol 118:238–243

    Article  PubMed  Google Scholar 

  13. Zeppa P, Marino G, Troncone G, Fulciniti F, De RA, Picardi M, Benincasa G, Rotoli B, Vetrani A, Palombini L (2004) Fine-needle cytology and flow cytometry immunophenotyping and subclassification of non-Hodgkin lymphoma: a critical review of 307 cases with technical suggestions. Cancer 102:55–65

    Article  PubMed  Google Scholar 

  14. Metzgeroth G, Kuhn C, Schultheis B, Hehlmann R, Hastka J (2008) Diagnostic efficacy of cytology and immunocytology in carcinomatous effusions. Cytopathology 19:205–211

    Article  PubMed  CAS  Google Scholar 

  15. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD (1997) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17:3835–3849

    Google Scholar 

  16. Savage EC, Vanderheyden AD, Bell AM, Syrbu SI, Jensen CS (2011) Independent diagnostic efficacy of flow cytometry obtained from fine-needle aspirates: a 10-year experience with 451 cases. Am J Clin Pathol 135:304–309

    Article  PubMed  Google Scholar 

  17. Bangerter M, Brudler O, Heinrich B, Griesshamnuer M (2007) Fine needle aspiration cytology and flow cytometry in the diagnosis and subclassification of non-Hodgkin's lymphoma based on the World Health Organization classification. Acta Cytol 51:390–398

    Article  PubMed  Google Scholar 

  18. Alam K, Jain A, Maheshwari V, Siddiqui FA, Haider N, Khan AH (2011) Fine-needle aspiration cytology diagnosis of non-Hodgkins lymphoma in a resource-challenged environment. Diagn Cytopathol 39:461–467

    Article  PubMed  Google Scholar 

  19. Barrena S, Almeida J, Del CG-M, Lopez A, Rasillo A, Sayagues JM, Rivas RA, Gutierrez ML, Ciudad J, Flores T, Balanzategui A, Caballero MD, Orfao A (2011) Flow cytometry immunophenotyping of fine-needle aspiration specimens: utility in the diagnosis and classification of non-Hodgkin lymphomas. Histopathology 58:906–918

    Article  PubMed  Google Scholar 

  20. Ensani F, Mehravaran S, Irvanlou G, Aghaipoor M, Vaeli S, Hajati E, Khorgami Z, Nasiri S (2010) Fine-needle aspiration cytology and flow cytometric immunophenotyping in diagnosis and classification of non-Hodgkin lymphoma in comparison to histopathology. Diagn Cytopathol 40:305–310

    Article  PubMed  Google Scholar 

  21. Zeppa P, Vigliar E, Cozzolino I, Troncone G, Picardi M, De RA, Grimaldi F, Pane F, Vetrani A, Palombini L (2010) Fine needle aspiration cytology and flow cytometry immunophenotyping of non-Hodgkin lymphoma: can we do better? Cytopathology 21:300–310

    Article  PubMed  CAS  Google Scholar 

  22. 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 (2009) Hodgkin's lymphoma: diagnostic difficulties in fine-needle aspiration cytology. Diagn Cytopathol 37:564–573

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer Ufer 1-3, 68163, Mannheim, Germany

    Georgia Metzgeroth, Sebastian Reiter, Wolf-Karsten Hofmann & Jan Hastka

  2. Institut für Klinische Chemie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany

    Sven Schneider

  3. Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Germany

    Christoph Walz

  4. Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany

    Alexander Marx

Authors
  1. Georgia Metzgeroth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sven Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Walz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastian Reiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolf-Karsten Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Hastka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Hastka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Metzgeroth, G., Schneider, S., Walz, C. et al. Fine needle aspiration and core needle biopsy in the diagnosis of lymphadenopathy of unknown aetiology. Ann Hematol 91, 1477–1484 (2012). https://doi.org/10.1007/s00277-012-1476-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-012-1476-4

Keywords

Search

Navigation