Differential Diagnosis of Malignant Lymphadenopathy Using Flow Cytometry on Fine Needle Aspirate: Report on 269 Cases

Carla Griesel; Minodora Desmirean; Tonya Esterhuizen; Sergiu Pasca; Bobe Petrushev; Cristina Selicean; Andrei Roman; Bogdan Fetica; Patric Teodorescu; Carmen Swanepoel; Ciprian Tomuleasa; Ravnit Grewal

doi:10.3390/jcm9010283

Differential Diagnosis of Malignant Lymphadenopathy Using Flow Cytometry on Fine Needle Aspirate: Report on 269 Cases

J Clin Med. 2020 Jan 20;9(1):283. doi: 10.3390/jcm9010283.

Authors

Carla Griesel¹, Minodora Desmirean^{2

3}, Tonya Esterhuizen¹, Sergiu Pasca⁴, Bobe Petrushev⁵, Cristina Selicean⁶, Andrei Roman^{6

7}, Bogdan Fetica⁶, Patric Teodorescu^{2

6}, Carmen Swanepoel¹, Ciprian Tomuleasa^{2

6}, Ravnit Grewal^{1

8

9}

Affiliations

¹ National Health Laboratory Services, Tygerberg Hospital, Cape Town 7505, South Africa.
² Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
³ Department of Pathology, Constantin Papilian Military Hospital, 400001 Cluj Napoca, Romania.
⁴ Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj Napoca, Romania.
⁵ Department of Pathology, Octavian Fodor Regional Institute for Gastroenterology, 400111 Cluj Napoca, Romania.
⁶ Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400015 Cluj Napoca, Romania.
⁷ Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj Napoca, Romania.
⁸ Faculty of Natural Sciences, University of Western Cape, Belville 7535, South Africa.
⁹ The South African National Bioinformatics Institute, Medical Research Council, University of the Western Cape, Belville 7535, South Africa.

Abstract

Introduction: Fine needle aspiration (FNA) is frequently the first noninvasive test used for the diagnostic workup of lymphadenopathy. There have been many studies showing its usefulness, especially in conjunction with other techniques for the diagnosis of lymphoma, but it remains inferior to histological examination. The data regarding this subject have mostly been reported mostly from first-world countries, but are scarce for emerging economies. Thus, the current study assesses the agreement between fine needle aspiration flow cytometry (FNA FC) and histology in the aforementioned region.

Material and methods: We conducted a retrospective study including the FNA FC adenopathy diagnoses made between January 2011 and December 2016 at the Tygerberg Hospital, Cape Town, South Africa. Additional variables included were the histological diagnosis, sex and age of the included patients.

Results: In the descriptive part of the current study, 269 FNA FC samples were included. The most frequent diagnoses made on these were represented by B-cell lymphoma, reactive adenopathy, no abnormality detected (NAD), and non-hematological malignancy. In the analytical part of the current study, there were 115 cases included that had both valid FNA FC and histological diagnoses. It could be observed that FNA FC can correctly diagnose B-cell lymphoma in most cases, but it is a poor diagnostic tool especially for Hodgkin lymphoma in this setting as only a four-color flow cytometer was available for diagnosis. Moreover, FNA FC diagnosis of reactive adenopathy and of no abnormalities detected was shown to frequently hide a malignant disease.

Conclusion: In countries with scarce resources, FNA FC represents a useful diagnostic tool in the case of B-cell lymphoma, but may misdiagnose reactive adenopathy. Thus, FNA FC should be used in a case-specific manner, in addition to as a screening tool, with the knowledge that in cases with a high clinical suspicion of lymphoma, histological diagnosis is a necessity.

Keywords: fine needle aspiration; flow cytometry; lymphoma.