Mathur Sandeep, Dawar Ramesh, Verma Kusum
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Indian J Pathol Microbiol. 2007 Jan;50(1):46-50.
Fine needle aspiration cytology (FNAC) enjoys popularity among clinicians worldwide, as a first line of investigation in all patients with lymphadenopathy and is preferred over biopsy because of its minimally invasive nature and cost-effectiveness. Although non-Hodgkin's lymphomas (NHL) are conventionally diagnosed and graded on biopsy specimens, it may be useful to be able to not only diagnose but also grade these cases on FNAC smears. The WHO and REAL classifications forming the basis of treatment in some centres rely on clinical features, immunocytochemistry and cytogenetics, which are beyond reach of most centres in the developing countries. This study therefore is aimed at diagnosing and grading NHLs on morphological parameters. The cytologic grading accuracy is compared with the histologic grades assigned according to the International Working Formulation (IWF) system which relies solely on morphological features, most important of which is cell size. Ninety five cases were retrieved over a 3 year period (May 2000 to April 2003). These were (i) cases where a cytological diagnosis of NHL or suspicious of NHL was made and corresponding histological sections available and (ii) cases where a diagnosis of NHL was made in histology and corresponding FNAC smears were available irrespective of the cytological diagnosis. The diagnostic accuracy of FNAC for NHLs was determined using histology as the gold standard. Cases were also graded on FNAC smears using a three tier grading system based upon cell size into low, intermediate and high grades. Cytologically assigned grades were correlated with the corresponding histological grades (IWF) to determine grading accuracy. An accurate diagnosis of NHL was thus possible in 67/95 (70.5%) cases. Overall accurate grading was seen in 65/95 (68%) cases using cytological criteria. Accurate cytologic grading was possible in 14/15 (93.33%) low grade, 11/18 (61.11%) intermediate and 40/62 (64.5%) high grade non Hodgkin's lymphomas. Kappa statistics revealed a very good agreement between cytological and histological grades for low grade NHL. The kappa scores for intermediate and high grade NHLs indicated moderate agreement. Using the two-tier system grading the kappa value for high grade lymphomas improved to 0.72, indicating good concordance. This study highlights the utility of FNAC as a morphological tool for diagnosing and grading NHLs in a significant number of cases. This modality may assist clinicians in management of cases of NHLs, especially in centres working within the constraints of limited availability or non availability of ancillary techniques.
细针穿刺抽吸细胞学检查（FNAC）在全球临床医生中颇受欢迎，是所有淋巴结病患者的一线检查方法，因其微创性和成本效益而比活检更受青睐。尽管非霍奇金淋巴瘤（NHL）传统上是通过活检标本进行诊断和分级的，但能够在FNAC涂片上不仅诊断而且分级这些病例可能会很有用。世界卫生组织（WHO）和修订欧美淋巴瘤分类（REAL）分类是一些中心治疗的基础，它们依赖于临床特征、免疫细胞化学和细胞遗传学，而这些在发展中国家的大多数中心难以实现。因此，本研究旨在根据形态学参数对NHL进行诊断和分级。将细胞学分级的准确性与根据国际工作分类法（IWF）系统指定的组织学分级进行比较，该系统仅依赖形态学特征，其中最重要的是细胞大小。在3年期间（2000年5月至2003年4月）检索到95例病例。这些病例包括：（i）做出NHL细胞学诊断或疑似NHL且有相应组织学切片的病例；（ii）组织学诊断为NHL且有相应FNAC涂片的病例，无论细胞学诊断结果如何。以组织学为金标准确定FNAC对NHL的诊断准确性。还使用基于细胞大小的三级分级系统对FNAC涂片上的病例进行分级，分为低、中、高等级。将细胞学指定的等级与相应的组织学等级（IWF）相关联，以确定分级准确性。因此，在67/95（70.5%）的病例中能够准确诊断NHL。使用细胞学标准，在65/95（68%）的病例中总体分级准确。在14/15（93.33%）的低级别、11/18（61.11%）的中级和40/62（64.5%）的高级别非霍奇金淋巴瘤中能够进行准确的细胞学分级。Kappa统计显示低级别NHL的细胞学和组织学分级之间有很好的一致性。中级和高级别NHL的Kappa评分表明一致性中等。使用两级系统对高级别淋巴瘤进行分级时，Kappa值提高到0.72，表明一致性良好。本研究强调了FNAC作为一种形态学工具在大量病例中诊断和分级NHL的实用性。这种方法可能有助于临床医生管理NHL病例，特别是在辅助技术有限或无法获得的中心。
