First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Am J Gastroenterol. 2012 Mar;107(3):397-404. doi: 10.1038/ajg.2011.350. Epub 2011 Oct 11.
In addition to morphology, immunophenotype and genetic abnormalities should be assessed during diagnosis and subclassification of lymphoproliferative disorders. The objective of this study was to evaluate the yield of endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) using a standard 19-gauge needle for diagnosis and subclassification of lymphoma, assessing the feasibility of immunohistological, flow cytometric, and cytogenetic assessments.
Two hundred forty patients with suspected lymphoma were referred for EUS-FNAB to our quaternary EUS center between June 2005 and December 2010. EUS-FNAB using a conventional 19-gauge needle was attempted for all patients, followed by histological assessments including immunohistological staining, flow cytometry, and cytogenetic analysis (G-band karyotyping). Among the patients, 152 were ultimately diagnosed with lymphoma. The primary outcome measure of this study was the sensitivity of histological assessment, including immunohistological staining, flow cytometry, and G-band karyotyping, for diagnosis and subclassification of lymphoma.
Among the 152 patients ultimately diagnosed with lymphoma, 147 patients (96.7%) were diagnosed by EUS-FNAB, and classification in accordance with the WHO (World Health Organization) system was also possible for 135 patients (88.8%) on the basis of histological findings, including immunohistological staining. Flow cytometry showed abnormal or unusual cell populations in 121 (79.6%) of the 152 patients diagnosed with lymphoma, and in 114 (90.5%) of the 126 patients diagnosed with B-cell lymphoma. Specific cytogenetic abnormalities were detected in 21 (13.8%) of the lymphoma patients.
EUS-FNAB using a standard 19-gauge needle has high diagnostic value for lymphoma. Immunophenotyping is usually possible, while cytogenetic abnormalities can be identified in a relatively limited number of patients.
在淋巴增生性疾病的诊断和分类中，除了形态学，还应评估免疫表型和遗传异常。本研究的目的是评估使用标准的 19 号针进行内镜超声引导下细针抽吸活检（EUS-FNAB）在诊断和分类淋巴瘤中的效果，评估免疫组织化学、流式细胞术和细胞遗传学评估的可行性。
2005 年 6 月至 2010 年 12 月期间，共有 240 例疑似淋巴瘤的患者被转介到我们的四级 EUS 中心进行 EUS-FNAB。所有患者均尝试使用传统的 19 号针进行 EUS-FNAB，随后进行组织学评估，包括免疫组织化学染色、流式细胞术和细胞遗传学分析（G 带核型分析）。在这些患者中，最终有 152 例被诊断为淋巴瘤。本研究的主要观察指标是组织学评估（包括免疫组织化学染色、流式细胞术和 G 带核型分析）对淋巴瘤的诊断和分类的敏感性。
在最终被诊断为淋巴瘤的 152 例患者中，147 例（96.7%）通过 EUS-FNAB 诊断，根据组织学发现，包括免疫组织化学染色，也可以对 135 例（88.8%）患者进行符合世界卫生组织（WHO）系统的分类。流式细胞术显示 152 例诊断为淋巴瘤的患者中有 121 例（79.6%）存在异常或异常细胞群，在 126 例诊断为 B 细胞淋巴瘤的患者中有 114 例（90.5%）存在异常。在 21 例（13.8%）淋巴瘤患者中检测到特定的细胞遗传学异常。
使用标准的 19 号针进行 EUS-FNAB 对淋巴瘤具有很高的诊断价值。通常可以进行免疫表型分析，而在相对有限数量的患者中可以识别细胞遗传学异常。
