Department of Pathology, Duke University Hospital, Durham, NC.
Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shengyang, China.
Am J Clin Pathol. 2019 Nov 4;152(6):782-798. doi: 10.1093/ajcp/aqz107.
Use of fine-needle aspiration/needle core biopsy (FNA/CNB) in evaluating hematolymphoid processes has been debated. We investigate its applicability in various clinicopathologic settings.
We retrospectively analyzed 152 cases of FNA/CNB.
Of 152 FNA/CNBs, 124 (81.6%) resulted in diagnoses without excisional biopsies, while 28 required subsequent excisional biopsies. Of these, 43 FNA/CNBs performed for suspected lymphoma relapse demonstrated 95.4% diagnostic rate (41/43), which was significantly better than those without history of lymphoma (77/109, 71%; odds ratio [OR], 8.5; confidence interval, 1.9-37.4). Patients with immunodeficiency also showed a high rate of diagnosis by FNA/CNB (100%). When stratified by types of disease, diffuse large B-cell lymphoma/high-grade B-cell lymphoma demonstrated a higher success rate (92.7%) than small B-cell lymphoma (79.2%), though the difference was not statistically significant (OR, 3.3; P value = .07). A subsequent excisional biopsy was required in 28 cases, 23 of which resulted in diagnoses concordant with the FNA/CNB. Five cases showed diagnostic discordance, reflecting pitfalls of FNA/CNB in unusual cases with complex pathology.
FNA/CNB is practical in evaluating most hematolymphoid lesions, with high efficacy in recurrent disease and some primary neoplasms with homogeneous/ aggressive histology, or characteristic immunophenotype.
在评估血液淋巴系统疾病时，细针抽吸/核心针活检（FNA/CNB）的应用一直存在争议。我们研究了其在各种临床病理环境下的适用性。
我们回顾性分析了 152 例 FNA/CNB 病例。
在 152 例 FNA/CNB 中，124 例（81.6%）无需进行切除活检即可获得诊断，而 28 例需要进行后续切除活检。在这 28 例中，43 例疑似淋巴瘤复发的 FNA/CNB 诊断率为 95.4%（41/43），明显高于无淋巴瘤病史的患者（77/109，71%；比值比[OR]，8.5；95%置信区间，1.9-37.4）。免疫缺陷患者的 FNA/CNB 诊断率也很高（100%）。按疾病类型分层，弥漫性大 B 细胞淋巴瘤/高级别 B 细胞淋巴瘤的成功率（92.7%）高于小 B 细胞淋巴瘤（79.2%），但差异无统计学意义（OR，3.3；P 值=.07）。28 例需要进行后续切除活检，其中 23 例与 FNA/CNB 诊断结果一致。5 例出现诊断不一致，反映了 FNA/CNB 在罕见的具有复杂病理的病例中的局限性。
FNA/CNB 在评估大多数血液淋巴系统疾病时非常实用，在复发疾病以及某些具有均匀/侵袭性组织学或特征性免疫表型的原发性肿瘤中具有较高的疗效。
