Dong H Y, Harris N L, Preffer F I, Pitman M B
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Mod Pathol. 2001 May;14(5):472-81. doi: 10.1038/modpathol.3880336.
We retrospectively reviewed our experience with the fine-needle aspiration biopsy (FNAB) diagnosis of primary and recurrent lymphoma to assess the ability of cytomorphology with and without ancillary flow cytometry (FCM) analysis to diagnose and subclassify these tumors according to the Revised European-American Lymphoma/World Health Organization classifications. We reviewed 139 consecutive FNABS of 84 primary and 55 recurrent lymphomas. FCM was successful in 105 (75%) cases. The overall results, including cases without FCM, included 93/139 (67%) true positive, 7 (5%) false negative, and 39 indeterminate (27 [19%] suspicious and 12 [9%] atypical) diagnoses of lymphoma. In cases with FCM, there were 80/105 (77%) true positive, no false negative, and 25 indeterminate diagnoses (15 [14%] suspicious and 10 [9%] atypical). The overall results of the 84 primary lymphomas were 55 (67%) true positive, 5 (5%) false negative, and 24 indeterminate (14[16%] suspicious and 10 [12%] atypical) diagnoses for lymphoma. Of the 68 primary lymphomas analyzed with FCM, 50 [74%] were true positives, and 28 were indeterminate (11 [16%] suspicious and 7 [10%] atypical). There were no false negatives. Diagnostic accuracy varied among lymphoma subtypes. Subclassification of the positive cases were initially conclusive in only 55/93 cases (59%). However, a retrospective review of the morphologic together with FCM data in 15 of the 23 unclassified cases improved the overall subclassification of positive cases to 77%. Subclassification was best in small lymphocytic lymphoma/chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, Burkitt's lymphoma, mantle cell lymphoma, and plasmacytoma (all 100%). Subclassification was poor in marginal-zone lymphoma (33%), and initially as well in diffuse large B-cell lymphoma (62%), but it improved on review (95%), as did subclassification of follicular lymphoma (77 to 100% on review). Hodgkin's disease was recognized as malignant in only 44% of the cases (7/16) and was classified as such based on morphology alone. This review of our early efforts to diagnose and subclassify lymphoma with FNAB and FCM indicates that although a diagnosis and proper subclassification of lymphoma can be made with certainty in the majority of cases, recurrent or primary, it requires close coordination of cytomorphology and immunophenotyping data, which often comes with close cooperation of cytopathologists and hematopathologists. A mere cytological diagnosis of positive for lymphoma is no longer acceptable if FNAB is to become an independent diagnostic tool for lymphoma.
我们回顾性分析了经细针穿刺活检（FNAB）诊断原发性和复发性淋巴瘤的经验，以评估单纯细胞形态学以及联合辅助流式细胞术（FCM）分析，根据修订的欧美淋巴瘤分类/世界卫生组织分类对这些肿瘤进行诊断和分型的能力。我们回顾了84例原发性和55例复发性淋巴瘤的139例连续FNAB病例。FCM在105例（75%）病例中成功实施。总体结果，包括未进行FCM的病例，淋巴瘤诊断为真阳性93/139例（67%）、假阴性7例（5%）、不确定39例（可疑27例[19%]，非典型12例[9%]）。在进行FCM的病例中，真阳性80/105例（77%），无假阴性，不确定诊断25例（可疑15例[14%]，非典型10例[9%]）。84例原发性淋巴瘤的总体结果为淋巴瘤诊断真阳性55例（67%）、假阴性5例（5%）、不确定24例（可疑14例[16%]，非典型10例[12%]）。在68例经FCM分析的原发性淋巴瘤中，50例（74%）为真阳性，28例不确定（可疑11例[16%]，非典型7例[10%]）。无假阴性。淋巴瘤各亚型的诊断准确性各不相同。阳性病例的分型最初仅在55/93例（59%）中具有结论性。然而，对23例未分类病例中的15例进行形态学及FCM数据回顾性分析后，阳性病例的总体分型提高至77%。小淋巴细胞淋巴瘤/慢性淋巴细胞白血病、淋巴浆细胞性淋巴瘤、伯基特淋巴瘤、套细胞淋巴瘤和浆细胞瘤的分型最佳（均为[100%]）。边缘区淋巴瘤的分型较差（33%），弥漫大B细胞淋巴瘤最初也是如此（62%），但回顾时有所改善（95%），滤泡性淋巴瘤的分型也是如此（回顾时从77%提高至100%）。霍奇金病仅在44%的病例（7/16）中被诊断为恶性，且仅基于形态学分类。对我们早期使用FNAB和FCM诊断淋巴瘤并进行分型的工作进行回顾表明，尽管在大多数原发性或复发性淋巴瘤病例中能够确定诊断并进行正确分型，但这需要细胞形态学和免疫表型数据的密切协作，而这通常需要细胞病理学家和血液病理学家的紧密合作。如果FNAB要成为淋巴瘤的独立诊断工具，仅细胞学诊断为淋巴瘤阳性是不再可接受的。
