Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
Virchows Arch. 2024 Oct;485(4):591-604. doi: 10.1007/s00428-024-03819-3. Epub 2024 May 28.
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.
淋巴瘤的诊断主要依赖于临床检查和实验室探索。在后者中，组织活检的形态学和免疫组织化学分析是正确识别和分类疾病的基石。在伴有血液和/或骨髓受累的淋巴瘤中，多参数流式细胞术是有用的。这项技术也可以应用于从活检样本中释放的新鲜细胞。为了全面理解淋巴瘤，外科活检是最好的，实际上也是血液病理学界推荐的。然而，目前全球趋势是采用侵入性较小的程序，导致样本较小，如芯针活检或细针抽吸，这可能使诊断极具挑战性。在这篇综述中，介绍了在如此小体积的材料上进行准确淋巴瘤诊断的可能性和局限性。在回顾淋巴瘤诊断的主要步骤后，讨论了组织学、细胞学和流式细胞术各自的价值，包括小标本的处理。然后引出了综合方法的好处，接着讨论了在不同情况下应采取的态度。与许多病理学家的普遍观点相反，在小体积材料上进行完整诊断，结合相关辅助技术，通常是可能的，并且确实得到了最近文献的支持。最后，简要介绍了未来的发展，特别是人工智能工具的优势。总之，本文旨在为病理学家提供在面对小体积材料（如芯针活检或细针抽吸）时诊断淋巴瘤患者的方法概述。
